Claims Specialist: Quick Medical Claims Resolutions

Crawford & Company; Boise (ID); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

401(k) Retirement Plan

Tuition Assistance

Paid Holidays

Job summary

Crawford & Company is seeking a Claims Specialist to administer and resolve non-complex short-term claims with limited monetary authority. You will document files, determine liability, and work with claimants and medical professionals to close cases efficiently.

The role requires strong communication, detailed documentation, and adherence to state regulations. A valid driver's license and licensure as required by the state are essential, with opportunities for growth within Crawford.

Qualifications

• College degree or the equivalent of 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.

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 during processing.
• Identifies wage loss expenses and wage exposures on medical claims.
• Documents receipt and contents of medical reports; interacts with claimants to understand nature and extent of injury and medical conditions.
• Approves payments of medical bills on lost time disability claims within area of payment authority up to $2,500 after compensability has been determined.
• Evaluates medical 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 of activities and problems; refers matters beyond limits of authority for direction.

Skills

Claims knowledge

Communication skills

Customer-focused

License required

Education

College degree or equivalent

Associate in Claim designation

Job description

Crawford & Company is seeking a Claims Specialist to administer and resolve non-complex short-term claims with limited monetary authority. You will document files, determine liability, and work with claimants and medical professionals to close cases efficiently.

The role requires strong communication, detailed documentation, and adherence to state regulations. A valid driver's license and licensure as required by the state are essential, with opportunities for growth within Crawford.