Claims Specialist-WC

Job Description Administers and resolves non-complex short-term claims of low monetary amounts, including medical-only claims. Documents and monitors open case inventory and ensures proper and timely closing of files. Makes decisions on claims within delegated limited authority. Responsibilities Conduct investigations of claims to confirm coverage and determine liability, compensability, and damages; work closely with claimants, witnesses, medical professionals, and other relevant parties. Verify policy coverage for submitted claims and notify the insured of any issues; determine and establish reserve requirements, adjusting reserves as necessary during claim processing. Identify wage loss expenses and wage exposures on medical claims. Document receipt and contents of medical reports; interact frequently with claimants to understand the nature and extent of injury and medical conditions. Handle other correspondence within authority, including material from team members and/or clients. Approve payments of medical bills on lost time disability claims within the 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 the Team Manager informed verbally and in writing of activities and problems within assigned responsibilities; refer matters beyond limits of authority and expertise to the Manager for direction. Provide input on completing status reports, initiating activity checks, and preparing widow’s statement of dependency forms under managerial guidance. 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 (e.g., Associate in Claims). Demonstrated thorough working knowledge of claim processing 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 with the ability to identify and understand customer needs and interact effectively with others. Must hold or acquire the appropriate license(s) as required by state(s) at the adjuster/supervisory/management level; possess a valid driver’s license and complete continuing education requirements as outlined by Crawford Educational Services. Benefits & Compensation Competitive base pay (pay range disclosed during offer). Bonus/Incentive Pay and other performance-based rewards, if applicable. Medical, Dental, and Vision Plans. Prescription Drugs coverage. HSA, HRA, and FSA accounts. Paid holidays, vacation, and sick leave. 401(k) retirement plan. Tuition assistance. Paid parental leave. Supplemental health benefits. Enhanced mental health support. Virtual physical therapy. Caregiving services. Life assistance program. Training programs that promote continuous learning and career progression. Sustainability programs that give back to the communities in which we operate. Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. #J-18808-Ljbffr