4 complex claims director jobs found in Lawrenceville

The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic workers’ compensation claims within delegated limited authority to best possible outcome, under the direct supervision of a senior claims professional, supporting the goals of claims department and of CorVel.  This is a remote role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claims, confirms policy coverage and acknowledgment of the claim Determines validity and compensability of the claim Establishes reserves and authorizes payments within reserving authority limits Manages non-complex and non-problematic medical only claims and minor lost-time workers’ compensation claims under close supervision 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...

CorVel is seeking a dynamic and experienced Special Investigation Director to lead our Special Investigations Unit (SIU). This role is critical in safeguarding the integrity of our claims and managed care operations while ensuring compliance with regulatory standards. The ideal candidate will combine investigative expertise with strategic leadership to enhance CorVel’s market image and deliver measurable results. This is a remote role.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Education & Training: Develop and deliver SIU training programs for CorVel claims and managed care personnel to ensure awareness of fraud indicators and compliance requirements. Data Mining & Analysis: Utilize ISO and other data sources to identify red flags and determine when further investigation is warranted. Vendor Audits: Review and analyze audit findings from strategic vendors to ensure adherence to contractual and regulatory obligations. Regulatory & Carrier...

The Claims Supervisor-Strategic is responsible for supervising a direct reports team of Senior Claim Specialists - Strategic, or assisting with the supervision of field claims specialists (indirect) as the need arises. The primary responsibility of this position is to ensure all quality, productivity and customer service criteria are met while adhering to company policies and procedures. The Claims Supervisor position is integral to the success of the company and requires regular and consistent attendance, supporting the goals of the claims department and CorVel. In this role, the supervisor will be a part of the corporate claims team and made available for special projects and assignments to support the field claims organization. Engagement with a field operation and their claims will usually last no more than 10 weeks at which time the role will be reassigned to a new strategic project. This is a hybrid role.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Supervises...

Company Details   Berkley Southeast is a member company of W. R. Berkley Corporation, a Fortune 500 Company, whose insurance company subsidiaries are rated A+(Superior) by A. M. Best Company. BSIG provides local underwriting, risk services, claim, marketing and audit services for agents and policyholders in Alabama, Georgia, Mississippi, South Carolina, North Carolina and Tennessee. We take a broad approach to underwriting for ‘best in class’ businesses, primarily in: construction, light manufacturing, wholesale, distribution and business service industries.   The Company is an equal employment opportunity employer.   www.berkleysoutheast.com Responsibilities The Sr. Claims Litigation Specialist – Construction Defect is a vital member of our Claims Department, primarily responsible for managing complex, high-exposure Construction Defect claims and Third-Party Property General Liability matters. This role demands...