CorVel Corporation

Claims Specialist

• Handle complex and high-profile Workers' Compensation claims following company standards
• Receive claims, confirm policy coverage, and acknowledge claims
• 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 subrogation and litigation
• Manage potential claim recoveries
• Report claims to the excess carrier 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, and safety requirements
• Perform additional duties as assigned

Senior Claims Specialist

Manager

• Provide in-person and telephonic Medical Case Management to injured workers
• Involve patients, physicians, healthcare providers, employers, referral sources, families, attorneys, advisors/clients, and coworkers in case management
• Discuss current and alternate treatment plans with physicians using medical and nursing knowledge
• 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 and discharge planning conferences
• Conduct home visits for initial evaluations
• Determine appropriateness of care and develop long-term care strategies
• Negotiate delivery of durable medical equipment and nursing services
• Manage a caseload of workers' compensation injured workers within a defined jurisdiction
• Facilitate injured workers' recovery
• Travel locally and potentially overnight, depending on worker injuries and needs
• Retrieve documents and log activities using CorVel's proprietary Case Management application
• Perform additional duties as required

Senior Claims Specialist

Medical Case Manager II