Claims Specialist-WC

Claims Specialist – Workers’ Compensation (Nevada) Ready to make a real impact? We’re looking for a sharp, proactive Claims Specialist to join our team. Responsibilities Administer and resolve non-complex, short-term Workers’ Compensation claims, including medical-only cases. Maintain accurate and up-to-date documentation while monitoring open claim inventory. Ensure timely and proper closure of claims in compliance with internal standards. Make claim decisions within delegated authority guidelines. Conduct investigations of claims to confirm coverage and determine liability, compensability, and damages. Verify policy coverage for submitted claims and notify the insured of any issues; determine and establish reserve requirements, adjusting reserves as necessary. Identify wage loss expenses and wage exposures on medical claims. Document receipt and contents of medical reports and interact frequently with claimants to understand the nature and extent of injury and medical conditions. Review and handle other correspondence within authority, including material from team members and/or clients. Approve payments of medical bills on lost time disability claims within an area of payment authority up to $2,500 after compensability has been determined. Evaluate medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Keep Team Manager informed verbatim and in writing of activities and problems within assigned area of responsibility; refer matters beyond limits of authority and expertise to Team Manager for direction. Provide input on the completion of status reports, initiate activity checks and/or widow's statement of dependency forms under the guidance of the team manager. Complete all reporting forms and file documentation. Adhere to client and carrier guidelines and prepare written updates for supervisor review. Perform other related duties as required or requested. Qualifications College degree or equivalent education and experience. Knowledge of claims and familiarity with claims terminology gained through industry experience or specialized courses. Demonstrated thorough working knowledge of claim processing and claim policies and procedures. Demonstrated understanding of basic medical terminology and appropriate medical tests for claimed conditions. Effective and diplomatic oral and written communication skills. Customer-focused approach, including the ability to identify and understand customer needs and interact 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 license maintenance. Benefits Pay and incentive plans that recognize performance excellence. Benefit programs that empower financial, physical, and mental wellness. 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. Equal Opportunity Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. #J-18808-Ljbffr