Medical Claim Analyst

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

Job Description

Under direct supervision, processes medical only claims within authority, processes other claims open only for the administration of medical benefits (i.e. maintenance claims without actuarial reserves); approves payments and claimant reimbursements on lost time disability claims, within authority, after compensability has been determined.

Job Description

Under direct supervision, processes medical only claims within authority, processes other claims open only for the administration of medical benefits (i.e. maintenance claims without actuarial reserves); approves payments and claimant reimbursements on lost time disability claims, within authority, after compensability has been determined.

Responsibilities

• Processes "M" Case claims (medical only) within area of payment authority up to, but not exceeding $3,500.
• Processes claims, other than “M” cases, where all issues (indemnity, legal, etc.) have been settled and the claim is only open for payment of medical benefits (i.e. maintenance claims not requiring actuarial reserves).
• Contacts, by telephone, insureds, claimants, and medical providers for additional information or medical verifications to verify and report the status of claims.
• May verify coverage on claims by following normal coverage confirmation procedures, as requested. Alerts Team Manager of any errors or discrepancies.
• 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 by the Team Manager or claim technician/handler.
• Informs Team Manager of all Workers Compensation "M" Case claims to be removed from the "M" Case classification per Claim Best Practice guidelines.
• Answers routine questions, orally and in writing, from agents, claimants, insureds, or other interested parties.
• 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.
• Consults with other departments and business units.
• Documents receipt and contents of medical reports. Reviews and handles other correspondence within authority including material from the team member, customer, or State.
• 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 along with recommendation to team manager for reassignment.
• With the team managers guidance, provides input on the completion of status reports, initiate's activity checks and/or widow's statement of dependency forms.
• 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

Qualifications

• College degree or the equivalent education and experience
• Two or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations.
• 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.

About Us

Why Crawford?

Because a claim is more than a number - it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time.

At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.

We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com .

Education

When you accept a job with Crawford, you become a part of the One Crawford family. And as part of the One Crawford family, we offer a comprehensive Total Rewards package to our employees to assist with their financial, health/wellness, continuing education/training and other needs:

• Competitive base pay

- The Pay Range/Salary represents the anticipated low and high pay that may be offered for this position. To determine the actual offer, Crawford considers a wide range of factors including the candidate’s previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours.

• Bonus/Incentive Pay and other Performance-Based Rewards, if applicable.
• We offer a well-rounded benefits package that encourages wellness and helps our employees to be an educated healthcare consumer. The core benefits* offered include:

• Medical, Dental and Vision Plans
• Prescription Drugs
• HSA, HRA, and FSA Accounts
• Paid Holidays, Vacation and Sick Leave
• 401(k) Retirement Plan
• Tuition Assistance
• Paid Parental Leave
• Supplemental Health Benefits

Other Benefits

currently available at no cost include: - Enhanced Mental Health Support

• Virtual Physical Therapy
• Caregiving Services
• Life Assistance Program
• The above information highlights some of the benefits currently available to eligible full-time employees.
• 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. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.