Claims Specialist - Medical Claims (Low-Complexity)

Crawford & Company; Peachtree Corners (GA); On-site; USD 50,000 - 65,000; Full time

Job summary

Crawford & Company administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and ensures proper and timely closing of files.

Makes decisions on claims within delegated limited authority. Conducts investigations to confirm coverage and liability, verifies policy coverage, and documents medical reports while interacting with claimants, witnesses, and medical professionals.

Qualifications

• College degree or equivalent education and experience.
• Knowledge of claims and familiarity with claims terminology gained through industry experience and/or courses.
• Thorough working knowledge of claim processing and policies.
• Basic medical terminology understanding.
• Effective and diplomatic oral and written communication skills.
• Customer-focused approach and ability to identify customer needs.
• Must have or secure and maintain required state licenses and a valid driver's license.

Responsibilities

• Conducts investigations to confirm coverage, liability, and damages; works with claimants, witnesses, and medical professionals.
• Verifies policy coverage, determines reserves, and adjusts as needed during processing.
• Identifies wage loss expenses on medical claims and documents medical reports.
• Interacts with claimants to understand injuries and medical conditions; handles correspondence and updates.
• Approves medical bill payments within authority up to $2,500 once compensability is determined.
• Evaluates medical claims for fraud, loss control, and recovery per policy and state regulations.
• Keeps Team Manager informed and refers matters beyond authority for direction.
• Completes reporting forms and file documentation; prepares updates for supervisor.

Skills

Claims processing

Medical terminology

Communication skills

Customer focus

Licensing requirements

Education

College degree or equivalent education/experience

Associate in Claim designation or equivalent

Job description

Crawford & Company administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and ensures proper and timely closing of files.

Makes decisions on claims within delegated limited authority. Conducts investigations to confirm coverage and liability, verifies policy coverage, and documents medical reports while interacting with claimants, witnesses, and medical professionals.