6 payment integrity analyst ii jobs found

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   KNOWLEDGE & SKILLS: Excellent customer service skills Excellent written and verbal communication skills Fast learner; develops knowledge and understanding of claims...

The Northeast Workers’ Compensation Regulatory Specialist is responsible for managing jurisdictional reporting, regulatory filings and compliance-related processes across the Northeast region.  This role ensures timely, accurate and compliant submission of filings, responses and payments to mitigate organizational risk and potential penalty exposure. The Specialist oversees HP and C-8.1 activity from intake through resolution, supports FROI/SROI reporting and exception processes and assists with OSHA and Medicare validation initiatives.  This role partners closely with claim professionals and leadership to strengthen regulatory workflows, identify trends, reduce penalties and support broader regulatory projects as assigned.  This is a hybrid role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Regulatory Filings & Compliance Oversight Manage HP and C-8.1 activity from intake through resolution, including review, rebuttal, corrective payment coordination and...

The Senior Claims Specialist handles complex and high-profile Workers' Compensation claims following company standards. This role works closely with case managers and attorneys, manages subrogation, and negotiates settlements. The Senior Claims Specialist ensures the best possible outcome for the claim, meeting customer service expectations, and supporting the goals of the Claims Department and CorVel. This is a remote role. Vermont license is required. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives claim, confirms policy coverage and acknowledgement of the claim Determines validity and compensability of the claim by investigating and gathering information regarding the claim and files necessary documentation with state agencies Establishes reserves and authorizes payments within reserving authority limits Develops and manages well documented action plans with the case manager and outcomes manager to reduce overall cost of the claim Coordinates early...

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 an onsite role. Once fully trained, the employee will be able to work from home one day per week. 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...

CorVel is hiring a No-Fault Adjuster (Claims Specialist) for our Client Site in Jamacia Queens, NY. The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic no-fault 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 an on-site position for our client site in Jamaica, Queens, NY. Once fully trained, the employee will be able to work from home one day per week. ESSENTIAL FUNCTIONS AND 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 no-fault claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and...

CorVel is hiring a No-Fault Adjuster (Claims Specialist) for our Client Site in Brooklyn, NY. The Claims Specialist manages within company best practices lower-level, non-complex and non-problematic no-fault 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 an on-site position for our client site in Brooklyn, NY. Once fully trained, the employee will be able to work from home one day per week. ESSENTIAL FUNCTIONS AND 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 no-fault claims under close supervision Communicates claim status with the customer, claimant and client Adheres to client and carrier...