Claims Investigator - Remote & Impactful

Crawford & Company in; Berkeley Heights (NJ); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

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

Job summary

Crawford & Company in Berkeley Heights, NJ is seeking a Full-time Senior Administrative Support to administer and resolve non-complex short-term claims of low monetary amounts, including Fast Track and Incident Only claims. You will verify coverage, set reserves, and document case progress while interacting with claimants and medical professionals.

The role requires a college degree or equivalent, claims knowledge, and the ability to communicate effectively.

Qualifications

• College degree or the equivalent education and experience.
• Knowledge of claims terminology gained through industry experience.
• Demonstrates a thorough working knowledge of claim processing and claim policies.
• Understanding of basic medical terminology and appropriate medical tests for claimed conditions.
• Effective and diplomatic oral and written communication skills.
• 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.

Responsibilities

• Conducts investigations of claims to confirm coverage and determine liability, compensability, and damages.
• Verifies policy coverage for submitted claims and notifies the insured of issues; determines and establishes reserves.
• Identifies applicable wage loss expenses and wage exposures.
• Documents receipt and contents of claim documents and medical reports; interacts with claimants and medical professionals.
• Approves payments within scope of payment authority.
• Evaluate claims for potential fraud, loss control and recovery.
• Keeps Team Manager informed of activities and problems within area of responsibility.
• Completes reporting forms and file documentation.
• Adheres to client and carrier guidelines and prepares updates for supervisor.
• Develops subrogation/third party recovery potential and follows recovery procedures.

Skills

Claims knowledge

Medical terminology

Communication skills

Licensing requirements

Driver's license

Education

Associate in Claim designation

Job description

Crawford & Company in Berkeley Heights, NJ is seeking a Full-time Senior Administrative Support to administer and resolve non-complex short-term claims of low monetary amounts, including Fast Track and Incident Only claims. You will verify coverage, set reserves, and document case progress while interacting with claimants and medical professionals.

The role requires a college degree or equivalent, claims knowledge, and the ability to communicate effectively.