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Medical Claim Analyst
at Crawford & Company in California
Based in Atlanta, Georgia, Crawford & Company (www.crawfordandcompany.com) is the world's largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with a global network of more than 700 locations in 63 countries. The Crawford System of Claims SolutionsSM offers comprehensive, integrated claims services, business process outsourcing and consulting services for major product lines including property and casualty claims management, workers’ compensation claims and medical management, and legal settlement administration. The Company’s shares are traded on the NYSE under the symbols CRDA and CRDB.
Position Summary:
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, $10,000.
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 (W, N, X, and Z Cases), 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.
Requirements:
Licensed as required by state and local jurisdictions
Thorough working knowledge of claim processing and claim policies and procedures
Understanding of basic medical terminology and appropriate medical tests for claimed conditions
Customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others
Preferred:
Two (2) or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 63 countries;
On-going training opportunities through every stage of your career;
Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://broadspire.contacthr.com/17329278
Position Summary:
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, $10,000.
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 (W, N, X, and Z Cases), 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.
Requirements:
Licensed as required by state and local jurisdictions
Thorough working knowledge of claim processing and claim policies and procedures
Understanding of basic medical terminology and appropriate medical tests for claimed conditions
Customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others
Preferred:
Two (2) or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 63 countries;
On-going training opportunities through every stage of your career;
Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
How to apply: DO NOT use the Apply Online button. Please copy and paste the following link into your browser address bar:
http://broadspire.contacthr.com/17329278
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Published on Oct 04, 2010
Viewed: 265 times
Viewed: 265 times
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