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Workers Compensation Claims Specialist

2 months ago

Glen Allen, Virginia, United States CorVel Corporation Full time
About the Role

CorVel Corporation is seeking a highly skilled and experienced Workers Compensation Claims Specialist to join our team. As a Claims Examiner, you will play a critical role in the analysis and management of complex workers' compensation claims.

Key Responsibilities
  • Analyze and process workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
  • Negotiate settlement of claims up to designated authority level and make claims payments.
  • Process complex or technically difficult claims.
  • Calculate and assign timely and appropriate reserves to claims and continue to manage reserve adequacy throughout the life of the claim.
  • Calculate and pay benefits due; approve all claim payments; and settle claims within designated authority level.
  • Develop and manage claims through well-developed action plans; continue to work the action plan to bring the claim to an appropriate and timely resolution.
  • Prepare necessary state filings within statutory limits.
  • Actively manage the litigation process; ensure timely and cost-effective claims resolution.
  • Coordinate vendor referrals for additional investigation and/or litigation management.
  • Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
  • Manage claim recoveries of all types.
  • Report claims to the excess carrier, respond to requests of directions in a professional and timely manner.
  • Frequently communicate with all appropriate parties involved with the claim.
  • Refer cases as appropriate to management.
  • Maintain professional client relationships.
  • Actively execute appropriate claims activities to ensure consistent delivery of quality claims service.
Key Accountabilities
  • Investigation: The quality of 3-point contacts and addressing of such issues as coverage, compensability, delay and/or denial of claim.
  • Reserving: The establishment and/or amendment of reserves using the philosophy of "most likely outcome".
  • File Management: The establishment, documentation, and execution of action plans.
  • Medical and Disability Management: Aggressive return to work and collaborative effort with the Medical Management Unit.
  • Litigation Management: Aggressive negotiation and disposition as well as control and direction of counsel.
  • Procedures: Timely and accurate state filings, payment of bills, and appropriate coding.
Requirements
  • 3+ years of Workers Compensation claims management experience.
  • In-depth knowledge of appropriate insurance principles and laws for workers' compensation.
  • Exceptional customer service skills.
  • Strong written and verbal communication skills.
  • Strong organizational skills.
  • Strong negotiation skills.
  • Strong analytical and interpretive skills.
  • PC literate.
  • Baccalaureate degree from an accredited college or university preferred.
  • Professional certification as applicable to workers' compensation required.