Medical Claim Analyst

Crawford & Company • Boise, ID

397d

About The Position

The Medical Claim Analyst position at Crawford & Company involves processing medical-only claims and other claims related to the administration of medical benefits. The role requires direct supervision and includes responsibilities such as approving payments, verifying medical information, and maintaining communication with various stakeholders. The analyst plays a crucial role in ensuring claims are processed efficiently and accurately, contributing to the overall mission of restoring lives through effective claims management.

Requirements

• College degree or equivalent education and experience.
• Two or more years of experience as a Claim Clerk or equivalent, with knowledge of computer entry and operations.
• Thorough working knowledge of claim processing and policies.
• 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.

Responsibilities

• Processes 'M' Case claims (medical only) within payment authority up to $3,500.
• Processes claims open only for payment of medical benefits, ensuring all issues have been settled.
• Contacts insureds, claimants, and medical providers for additional information or medical verifications.
• Verifies coverage on claims as requested and alerts Team Manager of any errors or discrepancies.
• Reviews and updates data into a computerized system.
• Approves payments of medical bills on lost time disability claims after compensability determination.
• Informs Team Manager of Workers Compensation 'M' Case claims to be removed from classification.
• Answers routine questions from agents, claimants, and insureds, both orally and in writing.
• Keeps Team Manager informed of activities and problems within assigned area of responsibility.
• Consults with other departments and business units as necessary.
• Documents receipt and contents of medical reports and handles correspondence within authority.
• Identifies files that no longer meet administrative criteria and recommends reassignment to Team Manager.
• Provides input on status reports and initiates activity checks or dependency forms as guided by Team Manager.
• Participates in special projects or performs duties in other areas as requested.

Benefits

• Pay and incentive plans that recognize performance excellence.
• Benefit programs that empower financial, physical, and mental wellness.
• Training programs for continuous learning and career progression.
• Sustainability programs that give back to the community.
• A culture of respect, collaboration, entrepreneurial spirit, and inclusion.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree