• Maintain oversight of commercial claims including complex and litigated matters • Perform second- and third-level reviews • Validate coverage, liability, reserves, and settlement strategies • Provide direction to TPAs, adjusters, and counsel • Perform file audits and QC checkpoints, track SLAs, cycle times, litigation rates, and recoveries • Support internal and external audit and develop remediation plans • Conduct routine claims audits and quality reviews • Develop and maintain claims dashboards to track trends, performance metrics, and program health • Partner cross-functionally with Athlete Safety to share claims data, loss trends, and emerging risk insights • Analyze claim outcomes across TPAs, jurisdictions, and programs to inform process improvements and underwriting insights • Submit GL and A&H claims and manage ongoing communication with TPAs • Support MGA financial and regulatory reporting, including carrier-specific and state-required submissions • Lead data cleanup initiatives across MGA and claims systems to improve reporting accuracy • Lead, mentor, and develop a growing team by establishing clear standards, workflows, and accountability

• Reviews the claim notice, contracts, state statutes and policies to verify the appropriate coverage, deductibles, and payees • Initiates timely contact with insureds and claimants to explain the claim process and initiate the investigation • Obtains statements from insureds, claimants, and witnesses and documents summaries within the claims system • Request and analyze investigative and other relevant reports, claim forms and documents when appropriate • Documents claim activities, reserve analysis, and summaries of reports including Medicare (MSP) modules in the claim system • Sets timely, adequate reserves in compliance with the company reserving philosophy and methodology • Identifies, investigates, and proactively pursues opportunities for recovery including arranging of evidence preservation in legal compliance that meets custody, control, transfer, analysis, and disposition of physical and/or electronic evidence • Adheres to all state requirements regarding regulatory compliance by sending out letters/forms containing appropriate language according to timelines • Reviews bills, invoices and receipts for accuracy and appropriateness • Notifies people leader of claims that may need escalation or reassignment • Drafts reservation of rights and coverage denial letters with supervisor approval • Assigns vehicle/property damage appraisals and vehicle rentals • Makes recommendations to people leader on the assignment of independent adjusters • Provides prompt, detailed responses to agents, insureds, and claimants on the status of claims • Resolves questions of coverage, liability and the value of the claims and communicates with insureds and claimants to resolve claims in a timely manner • Prepares bodily injury and/or damage evaluations, negotiation ranges and target settlement numbers prior to negotiation. Obtains authority when required • Identifies and protects all liens as appropriate • Investigates Medicare liens and resolves issues in accordance with EMC and Medicare guidelines • Communicates with insureds, claimants, and attorneys to negotiate the settlement of claims • Prepares and issues settlement and release documents verifying accuracy and ensuring they are properly executed • Issues timely payments • Reviews and audits estimates written by independent adjusters for accuracy and to ensure the most cost-effective repair approach • Submits referrals to the Estimatics, Special Investigation, Subrogation, Medical Review Units and Claims Legal teams as appropriate • Prepares risk reports for Underwriting and Risk Improvement • Prepares claims and participates in claims roundtables to discuss unique cases to evaluate coverage and damage

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers’ compensation claims under close supervision, supporting the goals of claims department and of CorVel. This is a remote role. Essential Functions & Responsibilities: - Receives claims, confirms policy coverage and acknowledgement of the claim - Determines the validity and compensability of the claim - Establishes reserves and authorizes payments within established reserving authority limits - Communicates claim status with the customer, claimant and client - Adheres to client and carrier guidelines and participates in claims review as needed - Assists other claims professionals with more complex or problematic claims as necessary - Additional duties as assigned Qualifications - Excellent customer service skills - Excellent written and verbal communication skills - Fast learner; develops knowledge and understanding of claims practice, relevant statutes, and medical terminology - Ability to identify, analyze and solve problems - Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets - Strong interpersonal, time management, and organizational skills - Ability to work both independently and within a team environment Requirements - Bachelor's degree or a combination of education and related experience - Minimum of 1 year industry experience and claim handling - WC experience required - Licensed as required jurisdictionally Benefits - A comprehensive benefits package is available for full-time regular employees and includes: - 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 Company Description CorVel, 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. CorVel 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 the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

• Imagine being part of a team that’s not just shaping the future but actively driving it. • At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. • As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. • We are looking to add Claims Adjusters with Bodily Injury and Municipalities experience to timely and professionally adjust third party General Liability, Auto Liability, Errors and Omissions and Municipalities claims in which a claim exists for bodily injury, personal injury or wrongdoing. • We are seeking candidates with the ability to provide excellent customer service, properly analyze and apply coverage, and adjudicate Bodily Injury claims in a professional manner. • The ideal adjuster has the ability to work efficiently and effectively with insureds, claimants, attorneys and outside vendors to confirm coverage, determine liability and evaluate damages through timely and diligent claim investigations. • We are seeking candidates who hold a valid Florida license with the ability to quickly secure reciprocal licenses in other states, if necessary.