Claims Specialist-WC

Crawford & Company • Portland, OR

90d

About The Position

The position involves administering and resolving non-complex short term claims of low monetary amounts, including medical only claims. The role requires documenting and monitoring open case inventory to ensure proper and timely closing of files. The individual will make decisions on claims within delegated limited authority. A college degree or equivalent education and experience is required, along with knowledge of claims and familiarity with claims terminology gained through industry experience or specialized courses of study, such as the Associate in Claim designation. The candidate must demonstrate a thorough working knowledge of claim processing and claim policies and procedures, as well as an understanding of basic medical terminology and appropriate medical tests for claimed conditions. Effective and diplomatic oral and written communication skills are essential, along with a customer-focused approach to identify and understand customer needs and interact effectively with others. The candidate must secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level and possess a valid driver's license. Continuing education requirements as outlined by Crawford Educational Services must be completed, and additional courses may be required by jurisdiction for maintenance of the license.

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.
• 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.
• Effective and diplomatic oral and written communication skills.
• Customer-focused approach with the ability to identify and understand customer needs.
• 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.

Responsibilities

• Conducts 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 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 claimants to understand the nature and extent of injury and medical conditions.
• Reviews and handles other correspondence within authority including material from team members and/or clients.
• Approves payments of medical bills on lost time disability claims within area of payment authority up to $2,500 after compensability has been determined.
• Evaluates medical 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.
• Provides input on the completion of status reports, initiates 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.
• Performs other related duties as required or requested.

What This Job Offers

• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree