Medical Claim Analyst

Crawford & Company•St. Louis, MO

2d•$15 - $28•Remote

About The Position

Under direct supervision, the Medical Claim Analyst processes medical-only claims within their authority and processes other claims that remain open only for administration of medical benefits, such as maintenance claims without actuarial reserves. The role also approves payments and claimant reimbursements on lost-time disability claims within authority after compensability has been determined. The position involves claim processing, communicating with insureds, claimants, medical providers, agents, and other interested parties, maintaining computerized claim data, documenting medical reports and correspondence, and referring matters outside the role’s authority or expertise to the Team Manager. The analyst may also assist with status reports, activity checks, and dependency forms, and participate in special projects or other assigned duties.

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 non-“M” claims where all issues have been settled and the claim remains open only for payment of medical benefits, including maintenance claims not requiring actuarial reserves.
Contact insureds, claimants, and medical providers by telephone to obtain additional information or medical verifications, and verify and report claim status.
Verify coverage on claims using normal coverage confirmation procedures when requested, and 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 of Workers Compensation “M” Case claims that 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 within the assigned area, and refer matters beyond the role’s authority or expertise for direction.
Consult with other departments and business units.
Document receipt and contents of medical reports, and review and handle correspondence within authority, including material from team members, customers, or the State.
Process non-“M” claims where all medical issues have been settled and the claim remains open only for payment of long-term indemnity benefits.
Identify files that no longer meet administrative criteria and recommend reassignment to the Team Manager.
With the Team Manager’s guidance, provide input on status reports and initiate activity checks and/or widows’ statements of dependency forms.
Perform other related duties as required or requested, and participate in special projects or duties in other areas as requested.
Uphold the Crawford Code of Business Conduct and Crawford Code of Conduct.