Crawford & Company
Administers and resolves non-complex short-term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and ensures proper and timely closing of files. Makes decisions on claims within delegated limited authority.
Responsibilities
Conduct investigations of claims to confirm coverage and determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons implicated in the investigation and processing of claims.
Verify policy coverage for submitted claims and notify the insured of any issues; determine and establish reserve requirements, adjust reserves as necessary during claim processing.
Identify wage loss expenses and wage exposures on medical claims.
Document receipt and contents of medical reports. Interact frequently with claimants to understand the nature and extent of injury and medical conditions. Review and handle other correspondence within authority including material from team members, and/or clients.
Approve payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined.
Evaluate medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
Keep Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refer matters beyond limits of authority and expertise to Team Manager for direction.
With the team manager’s guidance, provide input on the completion of status reports, initiate activity checks and/or widow's statement of dependency forms.
Complete all reporting forms and file documentation.
Adhere to client and carrier guidelines and prepare written updates for supervisor to review.
Perform other related duties as required or requested.
Qualifications
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 (Associate in Claim designation, etc).
Demonstrated thorough working knowledge of claim processing and claim policies and procedures.
Understanding of basic medical terminology and appropriate medical tests for claimed conditions.
Effective and diplomatic oral and written communication skills.
Customer-focused approach with the ability to identify and understand customer needs and interact effectively with others.
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. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license.
#LI-RG1
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 www.crawco.com.
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.
Benefits
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.
Sustainability programs 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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Responsibilities
Conduct investigations of claims to confirm coverage and determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons implicated in the investigation and processing of claims.
Verify policy coverage for submitted claims and notify the insured of any issues; determine and establish reserve requirements, adjust reserves as necessary during claim processing.
Identify wage loss expenses and wage exposures on medical claims.
Document receipt and contents of medical reports. Interact frequently with claimants to understand the nature and extent of injury and medical conditions. Review and handle other correspondence within authority including material from team members, and/or clients.
Approve payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined.
Evaluate medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
Keep Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refer matters beyond limits of authority and expertise to Team Manager for direction.
With the team manager’s guidance, provide input on the completion of status reports, initiate activity checks and/or widow's statement of dependency forms.
Complete all reporting forms and file documentation.
Adhere to client and carrier guidelines and prepare written updates for supervisor to review.
Perform other related duties as required or requested.
Qualifications
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 (Associate in Claim designation, etc).
Demonstrated thorough working knowledge of claim processing and claim policies and procedures.
Understanding of basic medical terminology and appropriate medical tests for claimed conditions.
Effective and diplomatic oral and written communication skills.
Customer-focused approach with the ability to identify and understand customer needs and interact effectively with others.
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. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license.
#LI-RG1
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 www.crawco.com.
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.
Benefits
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.
Sustainability programs 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.
#J-18808-Ljbffr