Detail-Oriented Medical Claims Processor

Crawford & Company; St. Louis (MO); On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical, Dental and Vision Plans

401(k) Retirement Plan

Tuition Assistance

Paid Holidays, Vacation and Sick Leave

Paid Parental Leave

HSA, HRA, and FSA Accounts

Job summary

Crawford & Company seeks a Claims Clerk to process medical-only and related claims under authority, approving payments and reimbursements on lost time disability claims after compensability is determined.

Under direct supervision, you will verify coverage, contact insureds/providers, and update records in a computerized system, coordinating with the Team Manager and other departments to ensure timely, accurate claim handling.

Qualifications

• College degree or the equivalent education and experience.
• Two or more years of experience as a Claim Clerk or the equivalent.
• 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 be licensed as required by state and local jurisdictions. Must complete designated continuing education courses while in position in order to advance.

Responsibilities

• Processes medical-only claims within area of payment authority up to, but not exceeding $3,500.
• Processes other claims open only for the administration of medical benefits.
• Contacts, by telephone, insureds, claimants, and medical providers for additional information.
• May verify coverage on claims and report status to Team Manager.
• Reviews and updates data into a computerized system.
• Approves payments of medical bills on lost time disability claims, within payment authority, after compensability has been determined.
• Informs Team Manager of all Workers Compensation 'M' Case claims to be removed from the 'M' Case classification.
• Answers routine questions, orally and in writing, from agents, claimants, insureds, or other interested parties.
• Keeps Team Manager informed of activities and problems; refers matters beyond limits to Team Manager.
• Consults with other departments and business units.
• Documents receipt and contents of medical reports.
• Processes claims, other than 'M' cases, where all medical issues have been settled and the claim is only open for payment of long term Indemnity benefits.
• Identifies files that no longer meet the administrative criteria and recommends reassignment.
• Performs other related duties as required or requested.
• Upholds the Crawford Code of Business Conduct at all times.
• Participates in special projects or performs duties in other areas as requested.
• Upholds the Crawford Code of Conduct

Skills

Claim processing knowledge

Customer communication

Medical terminology

Teamwork and collaboration

Attention to detail

Education

College degree or equivalent

Tools

Claim processing software

Job description

Crawford & Company seeks a Claims Clerk to process medical-only and related claims under authority, approving payments and reimbursements on lost time disability claims after compensability is determined.

Under direct supervision, you will verify coverage, contact insureds/providers, and update records in a computerized system, coordinating with the Team Manager and other departments to ensure timely, accurate claim handling.