Florida Workers Compensation Senior Claims Specialist
CorVel - Sunrise, FL
posted 4 months ago
About the position
The Senior Claims Specialist at CorVel is responsible for managing complex and high visibility workers' compensation claims in accordance with company standards and best practices. This role involves working closely with case managers and attorneys to ensure that claims are handled efficiently and effectively, with the goal of achieving the best possible outcomes for all parties involved. The Senior Claims Specialist will operate within a delegated limited authority to determine benefits due and will be tasked with managing subrogation and negotiating settlements. This position supports the overall goals of the claims department and the company, ensuring that customer service requirements are met throughout the claims process. In this hybrid role, the ideal candidate will reside in the areas of Martin, Palm Beach, Coral Springs, or Broward and will be required to travel to Palm Beach County once a month or as needed. The Senior Claims Specialist will receive claims, confirm policy coverage, and acknowledge the claims. They will investigate the validity and compensability of claims, gather necessary documentation, and file with state agencies as required. Establishing reserves and authorizing payments within reserving authority limits is also a key responsibility. The role requires the development and management of well-documented action plans in collaboration with case managers to reduce overall claim costs. The Senior Claims Specialist will coordinate early return-to-work efforts, manage subrogation and litigation aspects of claims, and report claims to excess carriers when applicable. Effective communication with customers and claimants regarding claim status is essential, as is adherence to client and carrier guidelines. The position also involves developing and maintaining professional customer relationships and complying with applicable state regulations. Additional projects and duties may be assigned as needed.
Responsibilities
- Receives claim, confirms policy coverage and acknowledgment of the claim
- Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies
- Establishes reserves and authorizes payments within reserving authority limits
- Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim
- Coordinates early return-to-work efforts with the appropriate parties
- Manages subrogation and litigation of claim as it applies
- Manages potential claim recoveries of all types
- Reports claims to the excess carrier when applicable
- Communicates claim status with the customer and claimant
- Adheres to client and carrier guidelines and participates in claims review as needed
- Develops and maintains professional customer relationships
- Complies with rules and regulations of applicable state
- Additional projects and duties as assigned.
Requirements
- Bachelor's degree or a combination of education and related experience
- Minimum of 3 years' industry experience and claim handling
- Self-Insured Certificate preferred
- State Certification as an experienced Examiner
- Bilingual in English and Spanish
- Excellent written and verbal communication skills
- Ability to assist team members to develop knowledge and understanding of claims practice
- Ability to identify, analyze and solve problems
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
- Strong interpersonal, time management and organizational skills
- Ability to work both independently and within a team environment
- Knowledge of the entire claims administration, case management and cost containment solution as applicable to Workers' Compensation.
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid time off
