Claims Specialist- Liab

Crawford & Company; New Orleans (LA); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Pay and incentive plans

Training programs

Benefits for wellness

Job summary

Crawford & Company is seeking a Claims Adjuster in New Orleans, Louisiana. This role involves investigating claims, ensuring proper documentation, and communicating with various stakeholders. The ideal candidate will have a college degree or equivalent experience and a working knowledge of claims processing.

The position offers excellent benefits that promote financial, physical, and mental wellness and emphasizes a culture of respect and inclusion. Join us to make an impact in the claims management industry.

Qualifications

• Knowledge of claims and familiarity with claims terminology.
• Demonstrates thorough knowledge of claim processing.
• Must secure and maintain required state license(s).

Responsibilities

• Conduct investigations of claims to confirm coverage.
• Document and monitor open case inventory.
• Evaluate claims for potential fraud issues.

Skills

Claims processing knowledge

Medical terminology understanding

Effective communication skills

Customer-focused approach

Education

College degree or equivalent education and experience

Job description

This is an exciting opportunity to join a global leader in claims management and make a meaningful impact through your expertise.

Excellent Crawford Benefits that Empower Financial, Physical, and Mental Wellness

Access to Multiple Employee Discounts

Administers and resolves non-complex, short-term claims with low monetary amounts, including Fast Track and Incident Only claims

Documents and monitors open case inventory to ensure proper and timely closure and billing of files

Makes decisions on claims within delegated and limited authority

Responsibilities

• Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims.
• 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, police reports etc. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients.
• Approves payments within scope of payment authority.
• Evaluates claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
• Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction.
• With the team managers' guidance, provides input on the completion of status reports, initiates activity checks and/or widow's statement of dependency forms.
• Completes all reporting forms and file documentation.
• Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
• Develops subrogation/third party recovery potential and follows recovery procedures.
• Participates in claim reviews as applicable.
• Performs other related duties as required or requested.

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. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license.

Compensation & Benefits

Our total compensation plans provide each of our employees with far more than just a great salary.

• Pay and incentive plans that recognize performance excellence.
• Benefit programs that empower financial, physical, and mental wellness.
• Training programs that promote continuous learning and career progression while enhancing job performance.
• Sustainability programs that give back to the communities in which we live and work.
• A culture of respect, collaboration, entrepreneurial spirit and inclusion.

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer.