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Medical Claims Examiner

2 months ago

Cleveland Ohio, United States Crawford & Company Full time
Job Summary

Crawford & Company is seeking a highly skilled Medical Claims Examiner to join our team. As a Medical Claims Examiner, you will be responsible for processing medical only claims within authority, approving payments and claimant reimbursements on lost time disability claims, and verifying coverage on claims.

Key Responsibilities
  • Process medical only claims within area of payment authority up to $3,500.
  • Verify coverage on claims by following normal coverage confirmation procedures.
  • Approve payments of medical bills on lost time disability claims, within payment authority, after compensability has been determined.
  • Contact insureds, claimants, and medical providers for additional information or medical verifications.
  • Review and update data into a computerized system.
  • Inform Team Manager of all Workers Compensation "M" Case claims to be removed from the "M" Case classification.
  • Answer routine questions from agents, claimants, insureds, or other interested parties.
  • Keep Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility.
  • Consult with other departments and business units.
  • Document receipt and contents of medical reports.
  • Process claims, other than "M" cases, where all medical issues have been settled and the claim is only open for payment of long term Indemnity benefits.
  • Identify files that no longer meet the administrative criteria along with recommendation to team manager for reassignment.
  • Provide input on the completion of status reports, initiate activity checks and/or widow's statement of dependency forms.
Requirements
  • College degree or the equivalent education and experience.
  • Two or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations.
  • Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.
  • Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions.
  • Demonstrates effective and diplomatic oral and written communication skills.
  • Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others.