Claims Specialist - Workers' Comp Investigator

Crawford & Company in; Portland (OR); On-site; USD 48,000 - 62,000; Full time

Job summary

Crawford & Company is seeking a Claims Specialist-WC (Finance) to administer and resolve non-complex short term workers' compensation claims of low monetary value in Portland, OR. The role includes documenting case inventories and closing files, with decisions made within delegated authority.

The candidate should have a college degree or equivalent, familiarity with claims terminology, and a licensed adjuster status with required CE.

Qualifications

• College degree or the equivalent of education and experience.
• Knowledge of claims terminology gained through industry experience and/or specialized courses of study (Associate in Claim designation).
• Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.
• Understanding of basic medical terminology and appropriate medical tests for claimed conditions.
• Effective and diplomatic oral and written communication skills.
• Customer-focused approach identifying and understanding customer needs, interacting 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; continuing education requirements must be completed.

Responsibilities

• Conducts investigations of claims to confirm coverage and determine liability, compensability, and damages.
• Verifies policy coverage and notifies the insured of issues; determines and adjusts reserves.
• Identifies wage loss expenses and wage exposures on medical claims.
• Documents receipt and contents of medical reports; communicates with claimants to understand injuries.
• Approves payments of medical bills on lost time disability claims within authorized limits.
• Evaluates medical claims for potential fraud, loss control and recovery.
• Keeps Team Manager informed of activities and problems; refers matters beyond authority for guidance.
• Provides input on status reports and completes required forms and documentation.
• Adheres to client and carrier guidelines and prepares updates for supervisor review.
• Performs other related duties as required.

Skills

Claims knowledge

Communication skills

Customer service

License required

Medical terminology

Education

College degree

Associate in Claim designation

Job description

Crawford & Company is seeking a Claims Specialist-WC (Finance) to administer and resolve non-complex short term workers' compensation claims of low monetary value in Portland, OR. The role includes documenting case inventories and closing files, with decisions made within delegated authority.

The candidate should have a college degree or equivalent, familiarity with claims terminology, and a licensed adjuster status with required CE.