Medical Claim Analyst

Crawford•Saint Louis, MO

1d•Remote

About The Position

Under direct supervision, the Medical Claim Analyst processes medical-only claims within assigned payment authority and processes other claims that remain open solely for administration or payment of medical benefits. The role also approves medical payments and claimant reimbursements on lost-time disability claims within authority after compensability has been determined. The analyst gathers and verifies claim information, maintains computerized claim records, communicates with claimants and other interested parties, and refers matters outside their authority or expertise to the Team Manager. The position may also support status reporting, activity checks, and other claim administration tasks. The analyst is expected to uphold the Crawford Code of Business Conduct and Code of Conduct and may participate in special projects or perform other duties as requested.

Requirements

College degree or equivalent education and experience.
Two or more years of experience as a Claim Clerk or equivalent, demonstrating thorough knowledge of computer entry and operations.
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, including the ability to identify and understand customer needs and interact effectively with others.
Must be licensed as required by state and local jurisdictions.
Must complete designated continuing education courses while in the position in order to advance.

Responsibilities

Process medical-only (“M” Case) claims within payment authority, up to but not exceeding $3,500.
Process claims that are open only for payment of medical benefits after other issues have been settled, when actuarial reserves are not required.
Contact insureds, claimants, and medical providers by telephone to obtain information or medical verifications and report claim status.
Verify claim coverage by following normal coverage confirmation procedures when requested.
Alert the Team Manager to errors or discrepancies.
Review and update data in a computerized system.
Approve medical bill payments on lost-time disability claims within payment authority after compensability has been determined by the Team Manager or claim technician/handler.
Inform the Team Manager when Workers Compensation “M” Case claims should be removed from that classification under Claim Best Practice guidelines.
Answer routine oral and written questions from agents, claimants, insureds, and other interested parties.
Keep the Team Manager informed verbally and in writing about activities and problems in the assigned area, and refer matters beyond authority or expertise for direction.
Consult with other departments and business units.
Document receipt and contents of medical reports.
Review and handle correspondence within authority, including material from team members, customers, or the State.
Process claims that remain open only for payment of long-term indemnity benefits after medical issues have been settled.
Identify files that no longer meet administrative criteria and recommend reassignment to the Team Manager.
With guidance from the Team Manager, provide input for status reports and initiate activity checks and/or widow’s statement of dependency forms.
Perform other related duties as required or requested; participate in special projects or perform duties in other areas as requested.
Uphold the Crawford Code of Business Conduct and Crawford Code of Conduct.