Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Claims Specialist

Expired Job

Corvel Philadelphia , PA 19107

Posted 4 months ago

Qualified candidate must have strong background in investigation/evaluation of third party property damage, subrogation claims, strong field investigative experience and excellent written communication skills. Must hold a valid Florida adjuster license. Investigate and handle auto and general liability claims by investigating and gathering pertinent information to determine liability, analyze and evaluate property damage claims. Develop and manage well documented action plan with client, claimants and attorneys to obtain outstanding claim resolution with better outcomes that reduce overall claim costs. Position may require some travel for field investigations. Responsible for handling all subrogation cases. Will work closely with client in day to day claims handling.


Handles assigned bodily injury and property damage liability claims within rules, regulations, and laws including, but not limited to, general provisions of individual state vehicle code, state and federal regulatory compliance codes, laws, statutes and legal decisions.

Comply with carrier and company best practices for handling bodily injury and property damage claims within delegated limited authority to the best possible outcome under the supervision of a claims supervisor.


  • Multi-state individual adjuster licenses. (Texas & Florida required)

  • Conduct investigations and determine liability within time frames set forth within State Regulatory Compliance laws, codes, & statutes.

  • Notify the claimant of liability determination within time frames set forth within State Regulatory Compliance laws, codes, & statutes.

  • Analyze and establish reserves.

  • Obtain documentation of damages being claimed and evaluate claims for settlement.

  • Negotiate settlements within designated authority.

  • Complete appropriate claim reports for client and claims supervisor.

  • Establish plan of action to bring claims to a conclusion

  • Timely review of files on diary.

  • Manage litigation and direct defense counsel.

  • Control legal expenses.


  • Excellent written and verbal communication skills

  • PC literate, including Microsoft Office (Word, Excel)

  • Ability to conduct recorded interviews.

  • Ability to learn rapidly to develop knowledge and understanding of claims practices.

  • Ability to identify, analyze and solve problems.

  • Strong organizational skills

  • Good interpersonal skills

  • Ability to work independently

  • Ability to work in a team environment

  • Ability to meet or exceed performance competencies

Note-Employment Agencies: Please do not forward agency resumes. CorVel Corporation is not responsible for any fees related to unsolicited resumes.

Please be aware that CorVel generally does not review all applications/resumes submitted in response to job openings posted on the Internet because of the large volume of responses.

upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Service Delivery Pharmacy Benefit Claims Analyst

Amerihealth Caritas Health Plan

Posted 6 days ago

VIEW JOBS 1/10/2019 12:00:00 AM 2019-04-10T00:00 Summary: To maintain, review, and provide consultation on basic to moderately complex customer pharmacy benefits. The Benefit Claims Analyst also analyzes pharmacy claims reports to identify trends, issues, and present recommendations. Responsibilities: * Maintains current knowledge of Medicare requirements related to Part D Chapters 5, 6, and 14, as they pertain to pharmacy benefits and pharmacy claims adjudication. * Researches pharmacy benefit questions and claims related inquiries for Medicaid, Exchange, and Medicare plans. * Work with various levels of requests with varying degrees of escalation from internal and external departments to make recommendations for fulfillment of basic to moderately complex benefit requests. * Documents benefit designs submission to the claims-processing vendor and provide oversight and maintenance of this documentation. * Utilizes pharmacy claims-processing software to test pharmacy benefits, process claim transactions (adjustments/re-work), investigate issues, and provides strategic guidance on how to improve claims processing to management. * Prepares test plans, develops testing scenarios, and executes testing strategies. * Investigates reported claims defects and provides detailed summaries of analysis and all available solutions for immediate mitigation. * Analyzes and reports pharmacy claims processing activity and trends for appropriateness based on benefit design requirements from the customer and also for providing recommendations to management. * Reviews and writes comprehensive reports, identifies alternatives, and makes recommendations to management. * Participation and leadership in audits related to pharmacy benefits and claims-processing * Performs other related duties and projects as assigned by the department Director or Manager of Pharmacy Benefits * Supports and carries out the PerformRx Mission & Values * Adheres to all AmeriHealth Caritas and PerformRx policies and procedures * Maintains a current knowledge base of PerformRx programs, services, policies and procedures * Regularly reviews and adheres to standard operating guidelines, desktop procedures, checklists, templates, and memorandums issued to the department * Creates and supports an environment which fosters teamwork, cooperation, respect and diversity * Establishes and maintains positive communication and professional demeanor with PerformRx employees and customers at all times * Demonstrates and supports commitment to corporate goals and objectives. Education/Experience: * High School Diploma or equivalent required * Bachelor's degree preferred or equivalent work experience * CPhT or PTCB Certification preferred * Minimum three (3) years of PBM, pharmacy operations or claims processing experience required * Progressive and focused work experience in continuous improvement initiatives, project management and/or organizational development * Strong analytical, planning, organizational, communication and time management skills * Strong research skills including gathering and analyzing data from multiple sources * Effective technical writing skills * Working in a cross-functional team environment * Ability to interpret and apply rules, regulations, policies, and procedures * Effective interpersonal and communication skills including tact and diplomacy * Effective organizational and planning skills with attention to detail and follow through * Ability to maintain confidentiality Amerihealth Caritas Health Plan Philadelphia PA

Claims Specialist

Expired Job