CorVel Corporation

Claims Specialist

• Manage lower-level, non-complex, and non-problematic workers’ compensation claims within delegated limited authority
• Work under the direct supervision of a senior claims professional
• Receive workers’ compensation claims and confirm policy coverage and claim acknowledgment
• Determine claim validity and compensability
• Establish reserves and authorize payments within reserving authority limits
• Manage non-complex lost-time workers’ compensation claims under close supervision
• Communicate claim status with customers, claimants, and clients
• Adhere to client and carrier guidelines
• Participate in claims reviews as needed
• Assist other claims professionals with complex or problematic claims
• Complete additional projects and duties as assigned

• Handle complex and high-profile Workers’ Compensation claims according to company standards
• Work closely with case managers and attorneys
• Manage subrogation, litigation, and potential claim recoveries
• Negotiate settlements
• Receive Workers’ Compensation claims and confirm policy coverage and claim acknowledgement
• Investigate claims, determine validity and compensability, and file necessary documentation with state agencies
• Establish reserves and authorize payments within reserving authority limits
• Develop and manage documented action plans with case and outcomes managers to reduce claim costs
• Coordinate early return-to-work efforts
• Report claims to excess carriers when applicable
• Communicate claim status with customers and claimants
• Follow client, carrier, state, and workplace safety requirements
• Develop and maintain professional customer relationships
• Participate in claims reviews as needed
• Perform additional duties as assigned

Senior Claims Specialist

Manager

• Provide in-person and telephonic Medical Case Management to injured workers
• Collaborate with patients, families, physicians, healthcare providers, employers, referral sources, attorneys, clients, and coworkers
• Use medical and nursing knowledge to discuss treatment plans and alternate treatment plans with physicians
• Assess, plan, implement, and evaluate patient progress
• Evaluate treatment plans for appropriateness, medical necessity, and cost effectiveness
• Attend doctors’, healthcare providers’, home, and occasionally attorneys’ visits
• Attend hospital and long-term facility discharge planning conferences
• Conduct home visits for initial evaluations
• Negotiate delivery of durable medical equipment and nursing services
• Manage a caseload of workers’ compensation injured workers within a defined jurisdiction
• Travel locally up to approximately 60% of the work week/month and potentially travel overnight
• Perform additional duties as required

Medical Case Manager I

• Provide medical case management through coordination with patients, physicians, healthcare providers, employers, and referral sources
• Assess, plan, implement, and evaluate patient progress
• Evaluate treatment plans for appropriateness, medical necessity, and cost effectiveness
• Use medical and nursing knowledge to discuss current and alternative treatment plans with physicians
• Make medical recommendations to the payer
• Negotiate and coordinate delivery of durable medical equipment and nursing services
• Devise cost-effective medical care strategies
• Prepare organized reports within specified timeframes
• Maintain a minimum productivity standard of 95% per month
• Comply with safety rules and regulations under the Injury and Illness Prevention Program
• Perform additional duties as assigned

Telephonic Case Manager I

• Handle complex and high-profile Workers’ Compensation claims following company standards
• Receive Workers’ Compensation claims and confirm policy coverage and claim acknowledgement
• Investigate claims, determine validity and compensability, gather information, and file necessary documentation with state agencies
• Establish reserves and authorize payments within reserving authority limits
• Develop and manage documented action plans with case managers and outcomes managers to reduce claim costs
• Coordinate early return-to-work efforts
• Manage subrogation, litigation, and potential claim recoveries
• Report claims to excess carriers when applicable
• Communicate claim status with customers and claimants
• Adhere to client and carrier guidelines and participate in claims reviews
• Develop and maintain professional customer relationships
• Comply with applicable state rules and regulations and workplace safety requirements
• Perform additional duties as assigned

Claims Assistant

• Support claims staff in the setup and administration of workers’ compensation claims/case management
• Set up new claims
• Process mail and handle files until paperless
• Input notes/diary entries in the claims system
• Process payments as needed
• Process form letters, state forms, and reports
• Assist claims examiners with provider, claimant, and customer telephone calls
• Perform additional duties as assigned

• Manage mid to complex Auto and/or General Liability claims, including bodily injury and property damage
• Handle litigated files using delegated authority and company best practices
• Receive claims and confirm policy coverage and claim acknowledgment
• Determine claim validity and compensability
• Investigate and handle Auto and/or General Liability claims
• Establish reserves and authorize payments within reserving authority limits
• Communicate claim status with customers, claimants, and clients
• Adhere to client and carrier guidelines
• Participate in claims reviews as needed
• Collaborate with team members on complex or problematic claims
• Perform additional duties as assigned

Senior Liability Claims Specialist

Supervisor

• Supervise Workers’ Compensation claims staff in day-to-day operations
• Assist the Claims Manager with recruitment, interviewing and onboarding
• Ensure staff proficiency in procedures and job functions
• Ensure compliance with Workers’ Compensation laws and mandated regulatory reporting requirements
• Improve team performance through training, coaching and performance evaluations
• Recommend merit-based actions, subject to managerial approval
• Provide technical and jurisdictional guidance on compensability, investigations, litigation issues and service account instructions
• Liaise with clients and employees on claim-specific, procedural and special requests
• Recommend and execute final resolutions
• Participate in customer claim reviews and presentations
• Support claims department and company goals
• Maintain regular and consistent attendance
• Perform additional duties as assigned

Claims Supervisor

• Handle complex and high-profile Workers’ Compensation claims according to company standards
• Receive claims and confirm policy coverage and claim acknowledgement
• Investigate claims, determine validity and compensability, and file necessary documentation with state agencies
• Establish reserves and authorize payments within reserving authority limits
• Develop and manage documented action plans with case managers and outcomes managers to reduce claim costs
• Coordinate early return-to-work efforts
• Manage claim subrogation and litigation
• Manage potential claim recoveries
• Report claims to excess carriers when applicable
• Communicate claim status with customers and claimants
• Adhere to client and carrier guidelines and participate in claims reviews
• Develop and maintain professional customer relationships
• Comply with applicable state rules, regulations, safety rules and the Injury and Illness Prevention Program
• Support Claims Department and CorVel goals; perform additional duties as assigned

Account Manager

• Facilitate and coordinate customer set-up
• Coordinate and attend customer meetings
• Discuss, understand, and meet agreed-upon customer standards
• Develop and maintain account service instructions, communicate them to service staff, and post them on CorVel SharePoint
• Manage contract renewals and price increases with the AE and/or management team
• Resolve service issues and escalate operations issues as appropriate
• Manage all aspects of collections with operations management
• Present information to customers for contract renewals, service issue discussions, or additional product sales
• Oversee the integrity and delivery of client-specific reports
• Maintain continuous communication with customers to identify and maintain service expectations
• Mentor new Account Managers during onboarding and their first 24 months
• Compile monthly account updates and document new service opportunities in Salesforce
• Increase market share by providing excellent service and introducing additional services
• Perform additional duties as assigned

National Account Manager

• Provide in-person and telephonic Medical Case Management
• Work closely with injured workers to facilitate recovery
• Collaborate with patients, families, physicians, healthcare providers, employers, referral sources, attorneys, advisors/clients, and coworkers
• Manage a caseload of workers’ compensation injured workers within a defined jurisdiction
• Discuss current and alternate treatment plans with physicians
• Assess, plan, implement, and evaluate patient progress
• Evaluate treatment plans for appropriateness, medical necessity, and cost effectiveness
• Attend doctors’, providers’, home, attorney, hospital, and long-term facility visits or conferences
• Determine appropriateness of care and develop long-term care strategies
• Negotiate delivery of durable medical equipment and nursing services
• Travel locally up to approximately 60% of the work week/month
• Perform additional duties as required

Medical Case Manager II

Data Analyst

• Analyze and interpret data to provide strategic and tactical support
• Develop and implement data collection systems and strategies that optimize statistical efficiency and data quality
• Analyze collected data using statistical techniques and provide ongoing reports
• Identify, analyze, and interpret trends or patterns in complex data sets
• Support end-to-end analysis development, management, and delivery
• Interface with business and technical teams to understand context and business value in data
• Build relationships with internal customers and develop analytic solutions to meet business needs
• Produce dynamic, meaningful, clear, and informative reports and dashboards using standard business intelligence tools
• Help executive management solve highly complex problems
• Perform additional projects and duties as assigned

Data Analyst II

• Receives Workers’ Compensation claims, confirms policy coverage and acknowledgement of the claim
• Determines the validity and compensability of the claim
• Establishes reserves and authorizes payments within established reserving authority limits
• Communicates claim status with the customer, claimant and client
• Adheres to client and carrier guidelines and participates in claims review as needed
• Assists other claims professionals with more complex or problematic claims as necessary
• Performs additional duties as assigned

Medical Only Claims Specialist

• Gather demographic and clinical information on prospective, concurrent, and retrospective inpatient admissions and outpatient treatment
• Certify medical necessity and assign an appropriate length of stay
• Support the goals of the Case Management department and CorVel
• Identify the necessity of the review process
• Communicate issues of concern to appropriate claims staff/customers
• Collect data and analyze information to make certification or denial decisions
• Document all work appropriately
• Promote utilization review services with stakeholders
• Comply with safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program
• Perform additional duties as assigned

Utilization Review Case Manager I

• Handle complex and high-profile Workers’ Compensation claims following company standards
• Receive Workers’ Compensation claims and confirm policy coverage and claim acknowledgement
• Determine claim validity and compensability through investigation and information gathering
• File necessary documentation with state agencies
• Establish reserves and authorize payments within reserving authority limits
• Develop and manage documented action plans with case managers and outcomes managers to reduce claim costs
• Coordinate early return-to-work efforts
• Manage subrogation and claim litigation
• Manage potential claim recoveries
• Report claims to excess carriers when applicable
• Communicate claim status with customers and claimants
• Adhere to client and carrier guidelines and participate in claims reviews
• Develop and maintain professional customer relationships
• Comply with applicable state rules and regulations and workplace safety requirements