Claims Resolution Specialist

3 weeks ago


St Louis, Missouri, United States Crawford & Company Full time
Claims Resolution Specialist

We are seeking a skilled Claims Resolution Specialist to join our team at Crawford & Company. As a Claims Resolution Specialist, you will be responsible for administering and resolving non-complex short-term claims of low monetary amounts, including medical-only claims.

Key Responsibilities:

  • Conduct investigations of claims to confirm coverage and determine liability, compensability, and damages.
  • Verify policy coverage for submitted claims and notify the insured of any issues.
  • Identify wage loss expenses and wage exposures on medical claims.
  • Document receipt and contents of medical reports.
  • Approve payments of medical bills on lost-time disability claims within area of payment authority.
  • Evaluate medical claims for potential fraud issues, loss control, and recovery in accordance with insurance policy contracts, medical bill coding rules, and state regulations.

Requirements:

  • College degree or equivalent education and experience.
  • Knowledge of claims and familiarity with claims terminology gained through industry experience and/or specialized courses of study.
  • Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level.
  • 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.

About Us:

Crawford & Company is a global leader in claims management and outsourcing solutions. We are committed to helping our clients navigate the complexities of the claims process and providing exceptional service to their policyholders. Our team is dedicated to delivering innovative solutions and exceptional results.

Why Crawford?

We are a company that values our employees and provides opportunities for growth and development. We offer a comprehensive benefits package, competitive compensation, and a dynamic work environment. If you are a motivated and results-driven individual who is passionate about delivering exceptional service, we encourage you to apply for this exciting opportunity.



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