Claims Resolution Specialist

Crawford & Company; Berkeley Heights (NJ); On-site; USD 55,000 - 85,000; Full time

Job summary

Crawford & Company administers and resolves non-complex short term claims of low monetary amounts, including Fast Track and Incident Only claims. Documents and monitors open case inventory to ensure proper closing and timely billing.

Makes decisions on claims within delegated limited authority. The team handles investigations, confirms coverage, determines liability, and engages with claimants, medical professionals and witnesses.

Qualifications

• College degree or the equivalent education and experience.
• Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc).
• Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.
• Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions.
• Demonstrates effective and diplomatic oral and written communication skills.
• Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others.
• 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 to determine liability, compensability, and damages.
• Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
• Identifies applicable wage loss expenses and wage exposures.
• Documents receipt and contents of claim documents including medical reports and police reports; interacts with claimants to understand the injury and medical conditions.
• Approves payments within scope of payment authority.
• Evaluates claims for potential fraud issues, loss control and recovery.
• Keeps Team Manager informed of activities and issues within area of responsibility.
• Provides input on status reports and completes required forms.
• Completes reporting forms and file documentation.
• Develops subrogation/third party recovery potential and follows recovery procedures.
• Participates in claim reviews as applicable.

Skills

Claims knowledge

Medical terminology

Communication skills

Customer-focused

Driver's license

License eligibility

Liaison with stakeholders

Education

College degree

Associate in Claim

Job description

Crawford & Company administers and resolves non-complex short term claims of low monetary amounts, including Fast Track and Incident Only claims. Documents and monitors open case inventory to ensure proper closing and timely billing.

Makes decisions on claims within delegated limited authority. The team handles investigations, confirms coverage, determines liability, and engages with claimants, medical professionals and witnesses.