Florida Workers Compensation Senior Claims Specialist

$58,282 - $93,870/Yr

CorVel - Tampa, FL

Full-time - Mid Level

Hybrid - Tampa, FL

1,001-5,000 employees

Professional, Scientific, and Technical Services

About the position

The Senior Claims Specialist is responsible for managing complex and high visibility workers' compensation claims within company standards and best practices. This role involves determining benefits due, working closely with case managers and attorneys, managing subrogation, and negotiating settlements to achieve optimal outcomes for claims. The position supports the goals of the claims department and CorVel, and operates in a hybrid work environment.

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.

Nice-to-haves

• 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