Jobs at CorVel Corporation

Reviews prospective, concurrent, and retrospective inpatient and outpatient treatment for medical necessity and appropriate length of stay. Collects and analyzes clinical and demographic information, makes certification or denial decisions, documents reviews, communicates concerns to claims staff and stakeholders, and supports utilization review services. Requires nursing licensure, CPT and ICD knowledge, strong communication and organization skills, and clinical experience. Workers’ compensation and utilization review experience are preferred.

Handles complex Workers’ Compensation claims by investigating compensability, establishing reserves, authorizing payments, coordinating return-to-work plans, managing subrogation and litigation, negotiating settlements, and communicating with customers and claimants. The role ensures regulatory and client compliance, manages recoveries and excess-carrier reporting, maintains claim documentation, and collaborates with case managers, attorneys, and internal teams to control costs and achieve favorable outcomes.

Handles complex California workers’ compensation claims, including investigation, compensability decisions, reserves, payments, subrogation, litigation, settlements, recoveries, regulatory filings, and return-to-work coordination. Collaborates with case managers, attorneys, customers, claimants, and carriers while maintaining compliance, controlling claim costs, documenting action plans, and meeting service expectations.

Reviews workers’ compensation claim files, analyzes defenses, negotiates and resolves medical treatment liens, gathers supporting documents, prepares hearing packets and legal pleadings, and participates in WCAB conferences, trials, and hearings. The role requires strong communication, organization, problem-solving, Microsoft Office proficiency, and knowledge of WCAB procedures, labor codes, and state regulations.

Develops and deploys production machine learning models and data products for enterprise use. Responsibilities include data mining, feature engineering, model evaluation, NLP and LLM/RAG solutions, API and pipeline integration, cloud-based deployment, model validation, A/B testing, documentation, and lifecycle management. The role translates business needs into scalable data science solutions and collaborates with product, engineering, and business stakeholders throughout the SDLC.

Supervise a team of workers' compensation claims staff to meet quality, productivity, and regulatory requirements. Provide training, coaching, jurisdictional guidance, assist with hiring/onboarding, conduct performance evaluations, liaise with clients on claim resolutions, participate in claim reviews/presentations, and maintain required state licenses/certifications.

Develop and execute content marketing strategy; create and edit blog posts, white papers, case studies, email campaigns and videos; manage LinkedIn (organic/paid) and Sprout Social Advocacy; apply SEO best practices and keyword research; coordinate projects, deadlines, vendors, and cross-functional teams to drive brand awareness and engagement.

The Senior Corporate Paralegal prepares and manages corporate agreements, ensuring compliance while partnering with internal stakeholders to enhance contract efficiency.

Perform advanced data cleaning, statistical analysis, and multivariate modeling to produce dashboards and reports. Translate data into actionable recommendations, lead SDLC tasks, create BRDs, present findings to stakeholders, and mentor junior team members.

Perform advanced financial analysis, build and maintain complex models, lead budgeting and forecasting, deliver variance analysis and reports, support pricing/RFPs, calculate commissions/bonuses, audit financial processes, and mentor junior analysts while collaborating with cross-functional teams to inform strategic decisions.

Lead and manage a team of data scientists to design and deliver predictive models, optimization, text analytics, and statistical analyses. Communicate model behavior and results to the business, perform technical risk and reliability assessments, design multi-model algorithms, and apply engineering approaches and data-science libraries to solve enterprise problems.

Manage, build, and optimize email marketing campaigns and automated nurture programs. Use Marketing Cloud Account Engagement for segmentation, list management, and deployment. Analyze performance and deliverability, run A/B tests, ensure compliance (CAN-SPAM, GDPR), maintain list hygiene, and partner with content, design, Salesforce, and cross-functional teams to drive engagement and lead conversion.

Administer and maintain Salesforce and Marketing Cloud Account Engagement, build reports/dashboards, create automation (flows, validation rules), manage campaign setup and integrations, monitor data quality and lead routing, troubleshoot issues, document configurations, and train/support end users to drive marketing and sales alignment and platform adoption.

Contribute to corporate information security by assessing designs, selecting controls, performing threat modeling and vulnerability management, supporting risk and vendor assessments, and advising engineering teams on secure solutions and governance.

Prepare, review, and submit Workers' Compensation EDI FROI and SROI filings using vendor platforms. Analyze claim data, interpret state-specific EDI implementation guides and reporting rules, resolve transaction errors/rejects, monitor compliance with deadlines, communicate with internal stakeholders, and ensure HIPAA and regulatory compliance.

Coordinate telehealth inquiries via phone, email, fax; verify and enter medical referral orders; research escalations; provide coaching and training to assigned team; monitor workflows and recommend process improvements to ensure timely, accurate order submission and quality customer service.

Review, audit, and data-enter medical bills for multiple states and lines of business to ensure adherence to state fee schedules, customer guidelines, PPO discounts, and coding standards. Meet accuracy and productivity targets and perform related duties as assigned.

Supervise hospital bill audit nurses, ensuring accurate audits and compliance with regulations. Foster team collaboration and handle auditor inquiries while maintaining productivity standards.

Perform DRG validation reviews of medical records, document findings, provide support for coding determinations, and conduct audits to ensure accurate billing.

The Appeals Representative analyzes appeals in accordance with policies and guidelines, communicates with providers, and ensures timely completion of appeals while adhering to industry standards.