Claims Specialist
3 weeks ago
Position Summary:
Administers and resolves non-complex short term claims of low monetary amounts, including Fast Track and Incident Only claims. Documents and monitors open case inventory to ensure proper/timely closing and billing of files. Makes decisions on claims within delegated limited authority.
Responsibilities:
Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims.
Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim.
Identifies wage loss expenses and wage exposures on medical claims.
Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients.
Approves payments within scope of payment authority.
Evaluates claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction.
With the team managers guidance, provides input on the completion of status reports, initiate’s activity checks and/or widow’s statement of dependency forms.
Completes all reporting forms and file documentation.
Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
Develops subrogation/third party recovery potential and follows recovery procedures.
Performs other related duties as required or requested.
Requirements:
College degree or the equivalent of education and experience.
Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc).
Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level.
Must possess a valid driver’s license.
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.
About Us:
Why Crawford?
Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time.
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.
We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at .
When you accept a job with Crawford, you become a part of the One Crawford family.
Our total compensation plans provide each of our employees with far more than just a great salary
Pay and incentive plans that recognize performance excellence
Benefit programs that empower financial, physical, and mental wellness
Training programs that promote continuous learning and career progression while enhancing job performance
that give back to the communities in which we live and work
A culture of respect, collaboration, entrepreneurial spirit and inclusion
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.
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