New England Claims Specialist
CorVel
Job Summary
CorVel is hiring a remote New England Claims Specialist to investigate, manage, and process workers' compensation claims while ensuring compliance with client guidelines, claim regulations, and company procedures.
Job Description
The New England Claims Specialist is responsible for managing lower-level workers’ compensation claims from initial receipt through resolution. This role involves reviewing claim information, determining compensability, establishing reserves, authorizing payments, maintaining claim documentation, and communicating with claimants, clients, and customers regarding claim status.
The position requires strong analytical skills, investigation abilities, documentation management, and customer communication while working within established authority levels and company guidelines.
### Key Responsibilities
* Receive and review workers’ compensation claims
* Verify policy coverage
* Determine claim validity and compensability
* Establish claim reserves
* Authorize claim payments within authority limits
* Manage lost-time workers’ compensation claims
* Maintain claim documentation
* Communicate with claimants, customers, and clients
* Follow carrier and client guidelines
* Participate in claim reviews
* Assist with more complex claims as assigned
* Research and resolve claim-related issues
### Requirements
* Bachelor’s degree or equivalent combination of education and experience
* Strong written and verbal communication skills
* Analytical and problem-solving skills
* Microsoft Office proficiency
* Strong organizational skills
* Ability to work independently and on a team
* Ability to learn workers’ compensation regulations and processes
### Preferred Qualifications
* 1+ year of claims experience
* Insurance industry experience
* Workers’ Compensation experience
* Claims management experience
* Current Workers’ Compensation license or certification
### Benefits
* Remote work
* Medical, Dental, Vision
* 401(k) and Roth 401(k)
* Health Savings Account
* Flexible Spending Account
* Paid Time Off
* Career advancement opportunities
* Life and Disability Insurance
### Good Fit For
Candidates with experience in claims processing, fraud investigations, insurance operations, documentation review, payment research, compliance review, customer service, or administrative case management.
### Phone Level Breakdown
* Outbound calls: Moderate
* Inbound calls: Moderate
* Claim documentation: High
* Investigation work: High
* Administrative processing: High