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The Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.
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As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes.
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Workers Compensation (WC) Adjuster License required according to jurisdictional requirements. Develops subrogation and third party recovery potential and follows reclaim procedures.
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Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.
TemporaryRemoteExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them. Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre-existing disability.
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Litigation management - Direct, manage, and control the litigation process. Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
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Initiate the referral to the SIU of cases with suspected fraud. Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file. Review and approve all vocational rehabilitation plans.
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Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company. Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
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Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues.
TemporaryRemoteExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Investigates, evaluates and resolves complex and litigated workers' compensation claims in order to achieve prompt and appropriate outcomes. Tracks status of assigned clams, individually and in the aggregate, using available management reports and tools such as Excel, including but not limited to such information as permanency evaluations, hearing dates, attorney information, settlement evaluation, venue, judges, current litigation status, subrogation credits due, and overall financial outcomes.
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Great Place to Work®Most Loved Workplace® Forbes Best-in-State EmployerWorkers Compensation Claims ExaminerPRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The CA Workers Compensation Sr. Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve the best possible outcome in the claim, supporting the goals of claims department and of CorVel.
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A minimum of 7 years of progressively responsible experience in handling complex workers compensation claims and workers compensation litigation required. Working knowledge of workers compensation claims handling practices.
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Summary Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
TemporaryRemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
Full-timeExpandApply NowActive JobUpdated 2 days ago
workers compensation complex subrogation jobs
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