CorVel jobs - 261 jobs

The Indemnity 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 position. 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 necessary Additional duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to learn rapidly to develop knowledge and understanding of claims practice Ability to identify, analyze and solve problems Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to meet or exceed performance competencies Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year of industry experience and claims management preferred State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The Customer Service Associate I is a business-to-business role which is accountable for facilitating accurate resolution of internal and external inquiries and issues pertaining to processing for assigned clients. Also, responsible for timely response to inquiries and issues, while maintaining a high level of customer satisfaction. ** Schedule: Monday - Friday with a flexible start time between 7:30am - 9:00am PRINCIPAL RESPONSIBILITIES AND DUTIES: Independently analyzes issues and processes, and clearly communicates, both verbally and in writing, to routine questions, processing issues, and requests according to company defined procedures/standards. Researches and analyzes payment history and recognizes when to contact vendors or customers to resolve exceptions and make payment decisions in a timely manner for all clients. Acts as a positive representative of the company, both internally and externally, making customers and their needs the primary focus of one's actions by helping to develop customer relationships. Keeps management informed of significant issues that may require additional attention, or may threaten the account relationship, on a timely basis. Suggests changes and/or enhancements to existing procedures to improve service to clients and internal processes. Works independently and with other internal departments to coordinate file maintenance and client validation file/database updates. Seeks guidance from the appropriate resource on significant non-routine issues. Documents and reports on errors made by all other Utility departments. Works overtime as needed. Other duties as assigned. Training is onsite Monday-Friday from 8:30am-4:00pm for approximately 90 days. SKILLS/ABILITIES AND MINIMUM REQUIREMENTS: Good interpersonal skills that will maximize client responsiveness and facilitate development of a solid working relationship with both utility clients and other staff members. Strong organizational skills with the ability to handle multiple tasks simultaneously. Working knowledge of office equipment such as fax machine, copy machine, and telephone. Proficient in Microsoft Office. Good problem-solving skills and attention to details. College-level course work in a general or business administration area or equivalent experience. Minimum 6 months customer service experience in a general business environment or equivalent experience.

The Lead Project Manager plans, executes, and finalizes the most complex software related projects according to strict deadlines, verifying the completeness of requirements and coordinating the efforts of team members and consultants to deliver projects according to plan. This position defines and coordinates the execution of the test plans and scenarios necessary to verify and validate the solution, as well as monitors other Project Managers within the IT Department. PRINCIPAL RESPONSIBILITIES AND DUTIES: Establishes project scope, goals, and deliverables that support business goals in collaboration with senior management and a broad range of stakeholders including both business and IT. Responsible for the management and implementation of projects and programs across all project phases, following best practices Develops project plans and associated communications documents. Effectively communicates project expectations to team members and stakeholders in a timely and clear fashion. Ensure projects are delivered on time, within budget and to the satisfaction of the customer/sponsor Accountable for managing multiple partners and third-party vendors to ensure all parties understand and deliver project goals and business expectations. Negotiates with other department managers for the acquisition of required personnel from within the company. Identifies and manages project dependencies and critical path. Plans and schedules project timelines and milestones using appropriate tools. Tracks project milestones and deliverables. Develops and delivers progress reports and requirements documentation. Proactively manages changes in project scope, identifies potential crises, and devises contingency plans. Defines project success criteria and disseminates them to involved parties throughout project life cycle. Conducts project postmortems and creates a recommendations report in order to identify successful and unsuccessful project elements. Develops best practices and tools for project execution and management. Proactively manage risks and issues and respond quickly in the event one is triggered or realized Creates templates and standards to measure duration, milestones, resource requirements and costs to ensure successful delivery of assigned projects. Manages multiple, large projects with budgets over one million dollars. Manages complex multi-vendor projects which contain multiple streams (requirements, development, quality assurance). Partners and collaborates with business owners to minimize operational risk and disruption. Acts as a lead and mentor to other Project Managers across the IT Department. Other duties as needed or required. SKILLS AND ABILITIES REQUIRED: Strong familiarity with project management software such as Microsoft Project. Highly competent in use of MS Office tools Familiarity with business diagram tools like MS-Visio Relational database experience with Microsoft SQL Server. Technically competent with various software programs, such as Microsoft Office suite. Ability to work both independently and in a team-oriented, collaborative environment. Ability to conform to shifting priorities, demands, and timelines through analytical and problem- solving capabilities. Ability to elicit cooperation from a wide variety of sources, including upper management, clients, and other departments. Ability to bring project to successful completion through political sensitivity. Strong written and oral communication skills. Strong interpersonal skills. Adept at conducting research into project-related issues and products. Customer service skills. Ability to effectively prioritize and execute tasks in a high-pressure environment. MINIMUM LEVEL OF PREPARATION AND TRAINING NORMALLY REQUIRED: A bachelor's degree in computer science or business administration with an emphasis in management information systems or equivalent work experience. 7 years of direct work experience in a project management capacity, including all aspects of process development and execution. Certification in project management, Agile PMP (Project Management Professional) preferred APPLICATION PROCESS: You can directly apply through Cass's website at careers. Please apply directly to this position via the "Apply" button. You will be required to create an account and provide your resume, contact information and other pertinent employment information. This process typically takes 20 minutes or less. Should we find that you meet the minimum requirement of the position, a member of our recruiting team will be in touch to start the interview process. ABOUT OUR COMPANY: Cass Information Systems, Inc. is a leading provider of integrated information and payment management solutions. Cass enables enterprises to achieve visibility, control and efficiency in their supply chains, facilities and other operations. Disbursing over $90 billion annually on behalf of clients, and with total assets in excess of $2.3 billion, Cass is uniquely supported by Cass Commercial Bank. Founded in 1906 and a wholly owned subsidiary, Cass Commercial Bank provides sophisticated financial exchange services to the parent organization and its clients. Cass is part of the Russell 2000. More information is available at ***************** Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

A leading healthcare organization is seeking an Associate Director, Finance Data Management based in Honolulu, Hawaii. This role involves supporting all aspects of finance data management and implementing vital policies. Candidates must have a Bachelor's degree and extensive experience in ERP systems and finance functions. Additionally, proficiency in managing large datasets and SQL is required. Join a dynamic team to help enhance data architecture and improve operational efficiencies. #J-18808-Ljbffr

A national healthcare organization is seeking a Risk Management Lead to oversee risk adjustment operations and compliance. This role requires a minimum of three years of project leadership experience and expertise in audit and compliance. The ideal candidate will have strong relationship-building skills and the ability to manage multiple projects effectively. This remote position offers a salary range of $104,000 to $143,000 annually, along with competitive benefits including health insurance and a 401(k) plan. #J-18808-Ljbffr

FUNCTION: The Mailroom Associate is responsible for extracting, sorting, and reviewing utility invoices according to the department and customers' procedures. Extracts mail from an automated mail opening machine and sorts invoices, mail inserts, checks, terms, and invoices based on mode, number of pages, etc. Uses multiple separator sheets to organize utility bills prior to being scanned. Performs a manual review of utility invoices to ensure compliance with customer and department procedures. Separates bills which do not meet client and/or department standard procedures; attaches standard reject form and forwards to the lead for review. Meets established production quotas in a fast-paced mailroom production line environment. Maintains procedures including reviewing and complying with new or updated client and departmental procedures and discarding old procedures and files updates as received. Performs minor troubleshooting on the mail opening machine. Shows initiative in presenting problems and possible solutions to lead or supervisor. Maintains the work area to present a neat and professional appearance at all times. Works overtime as required by management to ensure timely completion of all accounts. Performs other duties as needed or assigned. SKILLS AND ABILITIES REQUIRED: Ability to regularly lift mail trays and letter debris up to 35 pound and physical capability of performing rapid repetitive hand/arm movements while opening/sorting mail that requires reaching. Ability to stand, bend and reach to file sheets the majority of the shift. Experience grasping, retaining instructions and performing at a high level of accuracy. Good organizational and time management skills to be able to work in a fast-paced production environment. Self-motivated with the ability to work under minimal supervision. MINIMUM LEVEL OF PREPARATION AND TRAINING NORMALLY REQUIRED: High school diploma or equivalent required. Equivalent experience found in a production-oriented processing environment preferred. APPLICATION PROCESS: You can directly apply through Cass's website at apply directly to this position via the "Apply" button. You will be required to create an account and provide your resume, contact information and other pertinent employment information. This process typically takes 20 minutes or less. Should we find that you meet the minimum requirements of the position, a member of our recruiting team will be in touch to start the interview process. ABOUT OUR COMPANY: Cass Information Systems, Inc. is a leading provider of integrated information and payment management solutions. Cass enables enterprises to achieve visibility, control and efficiency in their supply chains, communications networks, facilities and other operations. Disbursing over $90 billion annually on behalf of clients, and with total assets in excess of $2.5 billion, Cass is uniquely supported by Cass Commercial Bank. Founded in 1906 and a wholly owned subsidiary, Cass Commercial Bank provides sophisticated financial exchange services to the parent organization and its clients. Cass is part of the Russell 2000. More information is available at ***************** Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

A leading health services company is hiring a Lead Experience Researcher to drive high-impact experiences by blending qualitative and quantitative research expertise. This position is crucial in uncovering unmet needs and informing strategic solutions while partnering with cross-functional teams. An ideal candidate will possess a Bachelor's degree, a minimum of five years in experience research methods, and a passion for human-centered innovation. This remote role offers a competitive salary range of $138,900 - $191,000, along with comprehensive benefits. #J-18808-Ljbffr

A leading healthcare company in the United States seeks a Market Vice President of Pharmacy Professional Practice to oversee compliance across pharmacies. This role involves ensuring adherence to regulations while leading a team of professionals. The ideal candidate will possess a Bachelor's degree in Pharmacy, an active pharmacist license, and have substantial experience in pharmacy compliance. Competitive compensation includes a salary range of $223,800 - $313,100 per year with bonus eligibility and comprehensive benefits. #J-18808-Ljbffr

A leading healthcare company is seeking an experienced Infrastructure Operations leader to drive innovation in AI and cloud technologies. The ideal candidate will have over 10 years in infrastructure, with a strong background in AI/ML, leading cloud operations for Azure and AWS. Key responsibilities include overseeing cloud strategy and governance, enhancing operational performance, and fostering partnerships across teams. This role offers a competitive salary and benefits focused on well-being. #J-18808-Ljbffr

A leading healthcare services company in Washington seeks a Workforce Management Professional 2 to analyze workforce needs and develop operational insights. The role requires 2+ years of scheduling experience, and proficiency in Microsoft Office. This remote position entails occasional travel for training. Competitive salary ranging from $59,300 to $80,900 per year, plus benefits focused on whole-person well-being. #J-18808-Ljbffr

Job Description 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 position. 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 practice, relevant statutes, and medical terminology Ability to identify, analyze and solve problems Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets Strong interpersonal, time management, and organizational skills Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor's degree or a combination of education and related experience Minimum of 1 year industry experience and claim handling WC experience required Licensed as required jurisdictionally PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $16.36 - $26.31 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The CERIS Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. Clinical and/or technical expertise is utilized to address the provision of medical care and to identify inappropriate billing practices and errors inclusive of, but not limited to; duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Completely document work and final conclusions in designated computer program Adhere to regular and consistent work attendance Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) and other requirements as outlined in the Employee Handbook Responsive to additional Professional Review job duties as assigned by management or determined by legislative changes and/or market changes KNOWLEDGE & SKILLS: Must be able to communicate concisely and effectively in writing and verbally Must have the ability to interface with the claims adjusters, attorneys, physicians and their representatives, and advisors/clients, and co-workers Must have the ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management Must also have a strong ability to negotiate provider fees effectively Must be computer literate Knowledge of worker's compensation claims preferred EDUCATION & EXPERIENCE: Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.10 codes is preferred Medical bill auditing experience preferred Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review experience preferred PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $47,061 - $70,236 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. About CERIS CERIS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The Appeals Team Lead will be responsible for providing expertise or general support in reviewing, researching, investigating, and resolving all types of appeals and grievances. Corresponds with appropriate parties regarding appeal issues, implications, and appeal determinations. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: • Answer team questions as needed • Monitor and work QC queue • Responsible for distribution of appeals • Review appeal submission documentation for information/documentation that may affect the review and take action accordingly • Review original findings for issues and/or errors • Consult with relevant internal parties and seek clarification as necessary • Create appeal response that appropriately addresses the issues/questions raised in the appeal • Follow all department processes and protocols in completing each step of the appeal process • Coordinate special instructions/requests with other internal departments to ensure proper handling of the appeal • Maintain a working knowledge of Worker's Compensation, Medicare, and Medicaid rules, as well as an understanding of CERIS policies • Other duties as assigned by supervisor and/or manager KNOWLEDGE & SKILLS: • Ability to work well individually and in a team environment • Proven strong leadership skills as a performer/leader • Knowledge of Medicare (CMS) and Medicaid regulations, regulatory compliance, Managed Care, and medical claims processing guidelines • MS Word, Excel and Outlook experience, which extends beyond just their basic functionality (i.e. - pivot tables, conditional formatting, advanced formulas) • Familiarity with medical terminology, medical coding, and medical billing regulations EDUCATION & EXPERIENCE: • 3+ years in healthcare customer service or insurance collections field • Experience working with customer support/client issue resolution management PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $19.62 - $31.56 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CERIS: CERIS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401 K, ROTH 401 K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion in addition to answering incoming telephone calls, supporting the goals of the Utilization Review / Case Management department, and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Takes calls relating to precertification requests Verifies that all patient, provider and facility information entered in system is accurate and up to date Enters notes and service requests in CareMC system Communicates with stakeholders in a timely and professional manner Additional duties as assigned KNOWLEDGE & SKILLS: Ability to handle multiple priorities in a high-volume, fast-paced, team-oriented environment Excellent written and verbal communication skills Ability to meet designated deadlines Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to remain poised in stressful situations and communicate diplomatically via all methods of communication Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: High School diploma or equivalent required A.A. degree or equivalent preferred PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $16.90 - $26.31 per hour A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

Job DescriptionMEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for a Medical Director! This position is 100% remote working eastern time zone business hours. This is a direct hire FTE position and a fantastic opportunity to join a well-respected organization and have a positive impact on the lives of millions of people. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Medicare Contractor Medical Director (CMD) provides medical leadership and decision making for an organization that serves as a Medicare Administrative Contractor (MAC). This role serves as a liaison between the Centers for Medicare and Medicaid Services (CMS) and stakeholders. CMDs play a vital role in developing Local Coverage Determinations (LCDs) and ensuring compliance with Medicare policies, reviewing medical claims, and promoting evidence-based healthcare. ESSENTIAL DUTIES & RESPONSIBILITIES Clinical Expertise and Consultation 30% Provide leadership in clinical program outreach to the practitioner/provider/supplier/beneficiary community. Provide direction and assistance to clinical staff in conducting provider education, as well as assist in the development of clinical guidelines as needed. Keep clinical knowledge up to date and abreast of medical practice and technology changes. Serve as a subject matter expert in medical and clinical areas relevant to the Medicare program. Provide clinical consultation to internal teams (e.g., medical review staff, appeals teams) and external stakeholders. Provide the clinical expertise, scientific literature analysis, claims data analytics to effectively focus medical polical policy and reviews on identified problem areas. Collaboration and Leadership 30% Collaborate with CMS and other Medicare Contractors (e.g., A/B or DME MACs and others) to develop and update medical policies and articles based on clinical evidence and regulatory requirements. Work with multidisciplinary teams within the MAC to improve processes and ensure compliance with CMS directives. Liaise with CMS staff, medical societies, and other stakeholders to align goals and address emerging issues. Represent the MAC at CMS meetings and industry conferences. Strengthen the quality improvement procedures with emphasis on decision consistency and clinical education of clinical staff through various mechanisms including but not limited to overseeing Inter-Reviewer Reliability (IRR) reviews. Program Integrity 20% Support program integrity initiatives, including identifying trends in inappropriate billing practices or noncompliance. Ensure the proper application of Medicare regulations, national and local coverage determinations (NCDs and LCDs), and clinical guidelines. Participate in all phases of LCD development by leading the Local Coverage Determination (LCD) process to include development, revision, retirement, education, and decision making. Collaborate with investigative teams and law enforcement when required. Medical Review (MR) and Appeals 10% Oversee medical review activities to ensure appropriate and consistent decisions on claim determinations including pre- and post-payment determinations. Provide leadership in developing and implementing MR Quality Assurance Programs. Provide leadership in effectively focusing MR and developing internal MR guidelines. Review complex or high-level appeals and provide guidance on the application of Medicare policies. Provide support to the claim appeal process including assistance in the development of position papers and participation in the administrative process when needed such as Administrative Law Judge (ALJ) hearings. Provider Education and Communication 10% Provide leadership in the provider community (including interacting with hospital/specialty associations). Educate providers, individually or as a group, regarding identified problems or medical policy. Maintain Professional and Organization Relationships Performs other duties as the supervisor may, from time to time, deem necessary. Travel within and outside the assignedjurisdictions, as needed. Expected to be no more than 3-4 weeks/year but could vary based on business needs. REQUIRED QUALIFICATIONS MD or DO degree from accredited Medical School Minimum of three years clinical practice experience as an attending physician Extensive knowledge of the Medicare program, particularly the coverage and payment rules Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in a role that involved developing coverage or medical necessity policies and guidelines. Knowledge, skill, and experience to evaluate clinical evidence, and to develop evidence-based medical necessity standards within the Medicare fee-for-service benefit structure Ability to develop strategies and processes to ensure evidence-based decision-making for policy in the Medicare population Basic understanding of medical coding conventions Ability to effectively communicate, collaborate with, and provide education on health care policy issues to both internal team members and external entities Ability to work collaboratively with internal staff to evaluate aberrancies, determine appropriate billing, coding, pricing, and utilization of services Proficiency with effective public speaking and ability educate providers Ability to work collaboratively with clinical and non-clinical team members Ability and desire to educate team members and external entities (i.e., CMS, providers, other federal agencies, law enforcement, etc.) Computer literacy, including proficiency using word processing, spreadsheets, presentation, and virtual meeting applications Ability to complete independent or computer-based training and education Certifications, Licenses, Registration: Current, active, valid, unrestricted license to practice medicine in at least one state or territory within the United States, never suspended or revoked in any state or territory of the United States Eligible for licensure within jurisdiction of enterpriseoperations Board Certified Doctor of Medicine or a Doctor of Osteopathy in a specialty recognized by the American Board of Medical Specialties for at least three years PREFERRED QUALIFICATIONS Experienced Physical Medicine and Rehabilitation (PM&R), Oncology, Radiology, Ophthalmology or Infectious Diseases professionals with five years of clinical practice MBA, MHA, MS in Management, or formal accredited coursework in medical systems management Demonstrated successful working experience in organized medicine group(s) (e.g., AMA, specialty society, state health department) as a committee chairperson or other leadership Medical Director experience in Medicare-related or commercial healthcare organization Coding and billing experience utilizing HCPCs, CPT, and ICD-10 codes Experience using GRADE methodology for literature analysis and performing systematic reviews Experience working with physician groups, beneficiary organizations, and/or congressional offices Would you like to know more about our new opportunity? For immediate consideration, please send your resume directly to John Burke at ******************** or apply online while viewing all of our open positions at ******************* ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

Job DescriptionDB2 DBA REMOTE ARC Group has an immediate opportunity for a Senior DB2 DBA! This position is 100% remote. This is starting out as a contract position running through July 2026 with strong potential to extend longer or possibly convert to FTE. This is a fantastic opportunity to join an established and well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Reference# 19521-1 Candidates must have permanent work authorization and work for any employer without sponsorship now or in the future. Third party candidates are not eligible for this role. Requirements: Required (must have): 10 or more years professional experience as an application z/OS DB2 DBA on V11+. 8 or more years LUW DB2 including installing, supporting, configuring, and upgrading DB2 LUW subsystems. Additional Requirements: In depth knowledge of the DB2 zOS architecture. Experience with Netezza Performance Server database administration Experience with DB2 Purescale environment Experience working with IBM on opening cases and working with them Experience in configuring and supporting Tier-1 mission critical databases as an application z/os DBA and LUW systems/infrastructure DBA. Good knowledge of capacity planning and architecture design for database server deployment. Proven experience in working in a mission critical environment in a multi-terabyte database platform, including analytics workloads. Good understanding of data warehouse concepts including data marts, data Lakehouse and data lakes. Perform routine maintenance on several database environments including application of updates, patches, and hotfixes for LUW servers Creating databases, migrating database objects from non-production to production environment. Designing and building data models, schemas, views, and tables to support application requirements Working knowledge of Database Security mechanism, data encryption, obfuscation, auditing using tools such as Guardium. Extensive experience designing and executing backup and recovery concepts and procedures Measure database performance and troubleshoot complex database issues, I/O bottlenecks, SQL Tuning/ Experience in using Nimsoft, Dynatrace or Datadog or other event management and performance monitoring tools. Good understanding of licensing options and optimization. Experience in scripting languages (shell or python or Perl) for automating DBA administrative tasks. Experience with automation tools such as Control-M. In-depth knowledge of IT industry database technologies and processes and business applications integrated with database technologies. Provide 24 x 7 Support to Critical production systems. Experience in working closely with the application development teams to resolve any performance related issues and provide application support. DB2 tools, JCL, Perf monitoring (Omegamon) and Query monitor for Z/OSDB2 Required Education: Bachelor's degree in related field or additional equivalent work experience. Interested? Email your most updated resume to *****************************, or apply online and explore other opportunities at******************* ARC Group is aForbes-ranked top 20 recruiting and executive search firm, connecting top technical talent with clients nationwide. We pride ourselves on understanding both candidates and clients goals and serving both with integrity and excellence. ARC Group is anequal opportunity workplace, committed to building a diverse workforce.

Job DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These positions are 100% remote. These are direct hire FTE positions with salary, benefits, etc. This is a fantastic opportunity to join a dynamic and well-respected organization offering tremendous career growth potential. At ARC Group, we are committed to fostering a diverse and inclusive workplace where everyone feels valued and respected. We believe that diverse perspectives lead to better innovation and problem-solving. As an organization, we embrace diversity in all its forms and encourage individuals from underrepresented groups to apply. 100% REMOTE! Candidates must currently have PERMANENT US work authorization. Sorry, but we are not considering any candidates from outside companies for this position (no C2C, 3rd party / brokering). SUMMARY STATEMENT The Clinical Review Nurse is responsible for reviewing and making medical determinations as to the validity of health claims and levels of payment in meeting national and local policies as well as accepted medical standards of care. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review. ESSENTIAL DUTIES & RESPONSIBILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary. 90% of time will be spent on one or more of the following activities depending on assignments: Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization: Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations. Conduct review of claim data and medical records to make clinical decisions on the coverage, medical necessity, utilization and appropriateness of care per national and local policies, as well as accepted medical standards of care. Review provider practices and identify issues of concern, overpayment and need for corrective action as necessary; includes surfacing potential fraud and abuse or practice concerns. May develop recommendations for further corrective action based on medical review findings. May refer for review, or implement, corrective action related to medical review activities. May process claims and complete project work in the appropriate computer system(s). The remaining 10% of time will be spent on the following activities depending on assignments: Identify providers needing education and individually educate providers who are subject to medical review processes: Initiate or participate in provider teaching activities, creating written teaching material, providing one on one education or education to a group as a result of a medical review (e.g., probe, progressive corrective action, consent, etc.) or appeal. This may involve discussion with CMS leaders and leaders in the provider community. Participate in special projects as assigned. REQUIRED QUALIFICATIONS * Valid nursing degree * 2 years' clinical experience * Excellent written and oral communication skills * Demonstrated experience with evaluating medical and health care delivery issues (e.g., Inpatient Rehab Facility) * Strong computer skills to include Microsoft Office proficiency * Valid unrestricted Registered Nurse (RN) license PREFERRED QUALIFICATIONS * Inpatient Rehabilitation Facility Experience * Bachelor of Science in Nursing (BSN) * Insurance industry experience * Certified Coder ARC Group is a Forbes-ranked a top 20 recruiting and executive search firm working with clients nationwide to recruit the highest quality technical resources. We have achieved this by understanding both our candidate's and client's needs and goals and serving both with integrity and a shared desire to succeed. At ARC Group, we are committed to providing equal employment opportunities and fostering an inclusive work environment. We encourage applications from all qualified individuals regardless of race, ethnicity, religion, gender identity, sexual orientation, age, disability, or any other protected status. If you require accommodations during the recruitment process, please let us know. Position is offered with no fee to candidate.

The Bill Review Manager is responsible for the overall operation of a designated bill review office. The Manager participates in formulating and administering company best practices as well as developing long-range goals and objectives, analyzing costs, activities and operations, supporting the goals of Bill Review department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Responsible for financial operations, including, but not limited to: productivity, profitability, expenses, budgeting, billing and collections Responsible for implementing new business development, including marketing and sales activities Responsible for directing a team of employees in their day-to-day operations ensuring productivity and quality goals are met in accordance with company expectations Responsible for quality provider, claims, and client interaction Responsible for human resources matters Must be able to travel overnight and attend meetings Requires regular and consistent attendance Visit CorVel customers and participate in training sessions with management Represents the company in a professional manner to both internal and external customers and clients Directs the performance and development of the employees in their department. Assures peak performance of the team through continued training and coaching, coupled with regular performance evaluations Ensures staff compliance with Workers' Compensation laws and ensures mandated regulatory reporting requirements Utilizes Jurisdictional Expertise and knowledge of regulatory rules, statutes and procedures governing the jurisdictions assigned to ensure compliance Acts as subject matter expert for appropriate jurisdictions May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be required to visit customers and participate in training sessions with management Monitors operational workflow and manages appropriate/adequate staffing levels and staff retention strategies Develops and oversees the implementation of common bill review practices and procedures Promotes operational efficiency and quality by continuously improving processes, people and systems to enhance efficiency, consistency and quality Ensures consistent and complete compliance with CorVel's policies and procedures Comply with all safety rules and regulations during work hours in conjunction with the Injury Illness Prevention Program (IIPP) Additional projects and duties as assigned KNOWLEDGE & SKILLS: Excellent written and verbal communication skills Ability to assist team members to develop knowledge and understanding of bill review practice Effective quantitative, analytical and interpretive skills Technical knowledge of laws, policies, and procedures in defined territory Strong leadership, management and motivational skills Ability to travel overnight and attend meetings if required Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc. Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to work both independently and within a team environment Knowledge of processing bills on multiple lines of business Knowledge of medical terminology, medical billing codes, applicable state fee schedules and/or U&C charge processing Contract interpretation Ability to be a liaison between multiple departments within the company EDUCATION & EXPERIENCE: Bachelor's degree, national certification or a combination of education and related experience Minimum of 2 years' experience medical billing and supervisory/management experience Certified Professional Coder (CPC) designation preferred Licenses as required PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote

The Indemnity 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 position. 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 necessary * Additional duties as assigned KNOWLEDGE & SKILLS: * Excellent written and verbal communication skills * Ability to learn rapidly to develop knowledge and understanding of claims practice * Ability to identify, analyze and solve problems * Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets * Strong interpersonal, time management and organizational skills * Ability to meet or exceed performance competencies * Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: * Bachelor's degree or a combination of education and related experience * Minimum of 1 year of industry experience and claims management preferred * State Certification as an Experienced Examiner PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. Pay Range: $51,807 - $83,551 A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote