Medical Claim Analyst
About The Position
The Medical Claim Analyst manages medical-only and maintenance claims under direct supervision, administering medical benefits and reviewing and approving payments and claimant reimbursements for lost-time disability claims within their authority after compensability has been established. This is a fully remote role focused on accurate claim processing, communication with claimants and other parties, and adherence to Crawford’s claim practices and Code of Conduct. The analyst processes medical-only and qualifying maintenance claims, handles medical bill payments within assigned authority, maintains claim data and documentation, and answers routine questions. The role refers issues beyond the analyst’s authority or expertise to the Team Manager and may assist with status reports, activity checks, and other related work. Crawford describes a total rewards package that includes pay, potential performance-based rewards, benefits for eligible full-time employees, training and career-development programs, and sustainability programs.
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 hold licenses required by state and local jurisdictions.
- Must complete designated continuing education courses while in the position in order to advance.
Responsibilities
- Processes medical-only “M” Case claims within payment authority, up to but not exceeding $3,500.
- Processes claims where other issues have been settled and the claim remains open only for payment of medical benefits, including maintenance claims not requiring actuarial reserves.
- Contacts insureds, claimants, and medical providers by telephone to obtain information or medical verifications and report claim status.
- May verify claim coverage using normal procedures and alert the Team Manager to errors or discrepancies.
- Reviews and updates data in a computerized system.
- Approves medical bill payments on lost-time disability claims within payment authority after compensability has been determined by the Team Manager or claim technician/handler.
- Informs the Team Manager of Workers Compensation “M” Case claims that should be removed from that classification under Claim Best Practice guidelines.
- Answers routine oral and written questions from agents, claimants, insureds, and other interested parties.
- Keeps the Team Manager informed about activities and problems in the assigned area and refers matters beyond authority or expertise for direction.
- Consults with other departments and business units.
- Documents receipt and contents of medical reports and reviews and handles other correspondence within authority, including material from team members, customers, or the State.
- Processes claims where medical issues have been settled and the claim remains open only for payment of long-term indemnity benefits.
- Identifies files that no longer meet administrative criteria and recommends reassignment to the Team Manager.
- With guidance from the Team Manager, provides input on status reports and initiates activity checks and/or widow’s statements of dependency forms.
- Performs other related duties as required or requested and participates in special projects or duties in other areas as requested.
- Upholds the Crawford Code of Business Conduct and Code of Conduct.
Benefits
- Competitive base pay.
- Bonus/incentive pay and other performance-based rewards, if applicable.
- Medical, dental, and vision plans.
- Prescription drugs.
- HSA, HRA, and FSA accounts.
- Paid holidays, vacation, and sick leave.
- 401(k) retirement plan.
- Tuition assistance.
- Paid parental leave.
- Supplemental health benefits.
- Enhanced mental health support at no cost.
- Virtual physical therapy at no cost.
- Caregiving services at no cost.
- Life Assistance Program at no cost.
- Training programs that promote continuous learning and career progression while enhancing job performance.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
