Workers' Compensation EDI Specialist I

Workers' Compensation EDI Specialist

CorVel is seeking an experienced and detail-oriented Workers' Compensation EDI Specialist to join our State Filing team. This position is responsible for the timely and accurate submission of First Reports of Injury (FROI) and Subsequent Reports of Injury (SROI) in compliance with state workers' compensation reporting requirements.

The ideal candidate will possess strong analytical and problem-solving skills, the ability to interpret state-specific EDI implementation guides and reporting matrices, and experience researching claim information to determine appropriate filing actions. This role requires a high level of accuracy, independent decision-making, and the ability to manage production expectations in a fast-paced environment.

Direct Workers' Compensation EDI experience is preferred but not required. We welcome candidates with transferable experience in insurance, claims, compliance, data analysis, or other detail-oriented roles who demonstrate strong problem-solving abilities, attention to detail, and the aptitude to learn complex state reporting requirements.

Successful candidates are naturally curious, analytical, and detail oriented. They enjoy researching complex issues, interpreting regulatory requirements, and ensuring accuracy in their work. They are comfortable working independently, communicating across departments, and balancing production expectations with compliance responsibilities.

This is a remote position.

Essential Functions and Responsibilities

• Prepare, review, and submit Workers' Compensation EDI FROI and SROI transactions utilizing vendor reporting platforms, including EBIX/WCIRS.
• Analyze claim activity and documentation to determine appropriate filings based on state-specific reporting requirements.
• Interpret state implementation guides, EDI reporting matrices, sequencing requirements, and jurisdictional filing rules.
• Research workers' compensation claims within Corvel's Claim System, CareMC to obtain required filing information and validate data accuracy.
• Review, investigate, and resolve EDI transaction errors, rejects, and acknowledgments to ensure timely acceptance by state agencies.
• Monitor filing compliance and ensure reports are submitted within required state reporting deadlines.
• Communicate with claims adjusters, account managers, and other internal stakeholders regarding missing or inaccurate claim information needed for reporting.
• Utilize available resources, including CareMC, Corvel's claim system, SharePoint, state workers' compensation websites, and internal procedures to resolve filing issues.
• Stay current on state reporting requirements, IAIABC standards, implementation guide updates, and industry best practices.
• Maintain productivity and quality standards while balancing multiple priorities and deadlines.
• Ensure compliance with HIPAA, privacy regulations, and company policies in all communications and work activities.
• Perform additional duties as assigned.

Knowledge, Skills, & Abilities

• Strong attention to detail and commitment to data accuracy.
• Ability to analyze complex information and make sound filing decisions based on state reporting requirements.
• Understanding of workers' compensation claims processes and terminology.
• Ability to interpret and apply state-specific EDI implementation guides, reporting matrices, and sequencing requirements.
• Strong critical thinking and problem-solving skills.
• Experience researching and resolving reporting errors and data discrepancies.
• Effective time management and prioritization skills in a production-based environment.
• Ability to independently manage workload while meeting deadlines and performance expectations.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office Suite, particularly Outlook, Excel, and Word.
• Ability to work effectively across multiple applications and systems in a paperless environment.
• Strong organizational skills and adaptability in a changing regulatory environment.

Education & Experience:

• High School Diploma, GED, or equivalent.
• Minimum one (1) year of experience in an administrative, data entry, customer service, insurance, claims, compliance, or other detail-oriented role.
• Demonstrated ability to work accurately in a fast-paced environment while managing multiple priorities and deadlines.

Preferred Qualifications

• Experience in Workers' Compensation claims, claims administration, insurance operations, EDI reporting, regulatory compliance, or a related field.
• Knowledge of Workers' Compensation terminology, claim processes, and state reporting requirements.
• Experience with First Reports of Injury (FROI), Subsequent Reports of Injury (SROI), EDI transactions, or electronic regulatory reporting.
• Familiarity with IAIABC standards, state implementation guides, or reporting compliance requirements.
• Experience researching and resolving data discrepancies, reporting errors, or rejected transactions.
• Associate's degree or coursework in Business, Insurance, Healthcare Administration, Information Systems, or a related field is a plus, but not required.

Pay Range: $16.54 - $24.95 per hour

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.