11 professional review specialist ii jobs found

The Provider Relations Specialist assists providers via phone and email with bill review questions and requests of varying complexity. This role is responsible for documenting bill review errors to improve team error rate trend. The Provider Relations Specialist acts as a positive and professional representative of our CorVel family. The role ensures compliance with company best practice standards while also enabling a consistent, timely delivery of our quality services. This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Communicate clearly and professionally with providers and other stakeholders via phone and email Understand Workers Compensation guidelines and various client contract language to interpret and support our bill review Navigate the bill review application to obtain accurate information for the callers Understand CorVel EORs as well as client-specific nuances Answer basic to complex State WC fee schedule and/or billing questions on...

The Workers’ Compensation 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 hybrid role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Receives Workers’ Compensation 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 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 necessary...

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 hybrid role.  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 return-to-work efforts with the...

The CareIQ Billing Specialist completes invoicing processes for all CareIQ Ancillary Healthcare services. Utilizing proprietary systems and knowledge from training, a CareIQ Billing Specialist will complete administrative review of vendor and provider bills, determine appointment type, and then generate vendor payments and customer invoices. This role operates with a high focus on accuracy and urgency to ensure that payment and invoice amounts are completed in alignment with contracted service level expectations. This is a remote role but for continuity of business with our management team, candidate must reside in eastern or central time zones.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides quality and professional inbound and outbound telephonic customer service to assist customer and vendors with billing questions Completes accurate data review and entry Learns and maintains knowledge of how to operate corporate proprietary systems Completes...

The CareIQ Billing Specialist completes invoicing processes for all CareIQ Ancillary Healthcare services. Utilizing proprietary systems and knowledge from training, a CareIQ Billing Specialist will complete administrative review of vendor and provider bills, determine appointment type, and then generate vendor payments and customer invoices. A CareIQ Billing Specialist operates with a high focus on accuracy and urgency to ensure that payment and invoice amounts are completed in alignment with contracted service level expectations. This is a remote position but for continuity of business with our management team, candidate needs to reside and work in the Central or Eastern time zones.   ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: Provides quality and friendly inbound and outbound telephonic customer service to assist customer and vendors with billing questions. Completes accurate data review and entry. Able to learn and operate corporate proprietary systems....

The Liability Claims Specialist manages non-complex and non-problematic Liability claims under direct supervision of a senior claims professional. This role aims to achieve optimal outcomes for both CorVel and our clients. The Liability Claims Specialist handles litigated files and works with delegated limited authority, adhering to company best practices. This role is available for onsite, remote, and hybrid work arrangements.   ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Manages non-complex and non-problematic medical only claims and minor lost-time liability claims under close supervision 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 Communicates claim status with the customer, claimant, and client Adheres to client and carrier guidelines and participates in claims review as needed Collaborates with...

Position Title Credit Products Analyst II - Commercial Banking   Location Work From Home FL, FL 32302   Job Summary The Commercial Credit Analyst II - Commercial Banking builds upon foundational credit experience by taking on more complex underwriting and portfolio management responsibilities. This role plays a key part in supporting Credit Products Specialists in assessing credit risk, structuring commercial loans, and monitoring portfolio performance. Analysts are expected to independently conduct financial analysis, prepare risk ratings, and provide insights on credit decisions, while continuing to refine industry expertise and technical skills.   Job Responsibilities: JOB RESPONSIBILITIES Credit Risk Analysis & Portfolio Management: Conduct financial spreading and risk rating analysis. Perform detailed credit due diligence and industry research. Prepare annual and periodic credit reviews. Monitor borrower performance and track financial covenants....

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. We are seeking detail‑oriented professionals to join our team as PIP Claims Adjuster Associates, supporting our claims in the state of Florida. This role offers the opportunity to build technical expertise while contributing to a high‑performing, results‑driven claims organization. Key Responsibilities • Applies advanced understanding of insurance policies written by the company, the...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. We are seeking detail‑oriented professionals to join our team as PIP Claims Adjuster Associates, supporting our claims in the state of Florida. This role offers the opportunity to build technical expertise while contributing to a high‑performing, results‑driven claims organization. Key Responsibilities • Applies advanced understanding of insurance policies written by the company, the...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. We are seeking detail‑oriented professionals to join our team as PIP Claims Adjuster Associates, supporting our claims in the state of Florida. This role offers the opportunity to build technical expertise while contributing to a high‑performing, results‑driven claims organization. Key Responsibilities • Applies advanced understanding of insurance policies written by the company, the...

National General is a part of The Allstate Corporation, which means we have the same innovative drive that keeps us a step ahead of our customers’ evolving needs. We offer home, auto and accident and health insurance, as well as other specialty niche insurance products, through a large network of independent insurance agents, as well as directly to consumers.  Job Description Responsible for investigating and confirming the facts of loss for advanced automobile accidents. Determines coverage, liability, damages and otherwise adjusts and negotiates claims within limit of authority. Job Description We are seeking detail‑oriented professionals to join our team as PIP Claims Adjuster Associates, supporting our claims in the state of Florida. This role offers the opportunity to build technical expertise while contributing to a high‑performing, results‑driven claims organization. Key Responsibilities • Applies advanced understanding of insurance...