CA WC Senior Claims Specialist SIP PRISM

Overview

CA WC Senior Claims Specialist (SIP, 4850, PRISM) — We are seeking a Sr. Claims Specialist for our Southern California Team. The Sr. Claims Specialist manages, within company standards and best practices, complex and high-visibility workers' compensation claims within delegated limited authority to determine benefits due; works closely with case managers and attorneys; manages subrogation and negotiates settlements to achieve the best possible outcome in the claim, supporting the goals of the claims department and Cor Vel.

This position is remote. Candidates must hold a self-insured certificate.

• Receives claim, confirms policy coverage and acknowledgement 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
• Complies with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program ("IIPP")
• Additional duties as assigned

• 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

• Bachelor s degree or a combination of education and related experience
• 4-5 years of California Workers’ Compensation claims handling experience required
• CA workers compensation adjuster license required
• Associates in Claims or Associates in Risk Management designation preferred
• 4850 experience required

Cor Vel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

Cor Vel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. Cor Vel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients.

We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across…