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.

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.

Lead end-to-end product management for PBM, Ancillary Benefit Management, and specialty network offerings. Define roadmap, ensure regulatory and contractual compliance, drive profitability and client metrics, coordinate cross-functional stakeholders, streamline operations, support RFP/pricing, and launch/optimize products to align with business objectives.

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.

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.

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