3 complex liability adjuster jobs found in Folsom

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.   This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager   Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time...

Pay Range: $60000 - $150000 / year Sign-On Bonus Opportunity of up to $4,000* Our Perks & Benefits: Unlimited/uncapped commission – your earning potential is in your hands Lucrative incentive sales plans, bonuses and sales contests to recognize your success No cold calling – we provide a high volume of inbound leads and walk in traffic Comprehensive paid training and licensing, plus on-going mentorship and development Recognition-focused culture that celebrates your achievements Comprehensive benefits package including medical, dental, vision and life insurance Paid time off to recharge and maintain a healthy work-life balance Retirement Plan (401k) with company-matched contributions Fitness Reimbursement – up to $15/month for gym memberships Employee Assistance Program – confidential support for personal or professional challenges at no cost Extra Perks – optional plans for disability, hospital indemnity, health...

The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of...