Medical Claims Specialist: Fast, Accurate Resolutions

Crawford & Company; Tampa (FL); On-site; USD 45,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) Plan

Paid Holidays

Job summary

Crawford & Company seeks a claims professional to administer and resolve non-complex short-term medical and liability claims. You will verify coverage, establish reserves, and authorize payments within delegated limits, while coordinating with claimants and medical professionals.

The role emphasizes thorough investigations, documentation, and adherence to client and carrier guidelines, with opportunities to contribute to loss control, fraud evaluation, and file closure under supervision.

Qualifications

• Requires a college degree or equivalent experience.
• Knowledge of claims terminology and processing.
• Familiarity with state regulations and licensing requirements.
• Strong communication and customer-focused service.
• Ability to maintain accurate documentation.

Responsibilities

• Conduct investigations to confirm coverage, liability, and damages.
• Verify policy coverage and determine reserves; adjust as needed.
• Identify wage loss expenses on medical claims.
• Document medical reports and communicate with claimants.
• Approve medical payments on lost-time disability claims up to $2,500 after compensability.
• Evaluate claims for potential fraud and loss control.
• Maintain status reports and alert management as needed.
• Complete reporting forms and file documentation.
• Adhere to client and carrier guidelines; provide updates to supervisor.
• Perform other related duties as required.

Skills

Claims processing

Investigation skills

Communication skills

Regulatory compliance

Education

College degree or equivalent

Associate in Claim designation

Job description

Crawford & Company seeks a claims professional to administer and resolve non-complex short-term medical and liability claims. You will verify coverage, establish reserves, and authorize payments within delegated limits, while coordinating with claimants and medical professionals.

The role emphasizes thorough investigations, documentation, and adherence to client and carrier guidelines, with opportunities to contribute to loss control, fraud evaluation, and file closure under supervision.