Jobs at CorVel Corporation

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.

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.

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.