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Claim Examiner III - Workers’ Comp
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:
Investigate and settle moderate-to-difficult claims for assigned lines of business promptly and equitably under general supervision. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices. Sets reserves and recommends reserve changes to supervisor and Company attorneys in preparing cases for litigation.
Responsibilities:
Receives claim assignment, confirms policy coverages and directs acknowledgement of claims.
Interprets and makes decisions using independent judgment on moderate-to-difficult claims and policy coverages and determines if coverage applies to claims submitted.
Investigates claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required.
Analyzes claims activity and prepares reports for clients/carriers and management.
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
Develops subrogation and third party recovery potential and follows reclaim procedures.
Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
Education:
Bachelor’s degree or equivalent experience required. Industry designations preferred, but not required (IIA, AIC, AEI, and/or CPCU)
Knowledge and Skills:
Ability to work independently while assimilating various technical subjects.
Good verbal and written communication skills.
Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
Strong ability to identify, analyze and solve problems.
Effective interpersonal skills to effectively interact with all levels of internal and external clients.
Experience:
Worker’s Comp – Technical claims investigations/settling experience with 3-6 years experience in Broadspire Claims or similar organization.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.
Decision Making/Interaction:
Workers’ Compensation
Contacts: Clients, Nurse Case Managers, Vendors, Attorneys, Physicians, Client Service Ddirectors, Service Center Managers, Team Managers, Home Office Claims.
Settlement Authority: $25,000 - $100,000
Direct Reports: None
Indirect Reports: None
Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU.
License Requirements: Per State or Jurisdictional requirements.
Claim Gravity:
Internal case classification of ‘W” or “X”, although additional classifications may be indicated due to designated staff arrangements with clients. Claims would include coverage or compensability issues, denials, subrogation, higher exposures and more complex issues and injuries. Can include more routine structured settlements and Medicare set-aside issues. The reserve authority level for this position is $100,000.
Special Requirements/Certifications/Requirements:
License Requirements: Per State or Jurisdictional requirements.
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 location in 63 countries
On-going training opportunities through every stage of your career
Strong benefits package including 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/15909307
Position Summary:
Investigate and settle moderate-to-difficult claims for assigned lines of business promptly and equitably under general supervision. Reviews coverages, determines liability and compensability, secures information, arranges property damage appraisals and settles claims utilizing claims best practices. Sets reserves and recommends reserve changes to supervisor and Company attorneys in preparing cases for litigation.
Responsibilities:
Receives claim assignment, confirms policy coverages and directs acknowledgement of claims.
Interprets and makes decisions using independent judgment on moderate-to-difficult claims and policy coverages and determines if coverage applies to claims submitted.
Investigates claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required.
Analyzes claims activity and prepares reports for clients/carriers and management.
Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements.
Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits.
Develops subrogation and third party recovery potential and follows reclaim procedures.
Analyzes claims activities and prepares reports for clients, carriers and/or management. Participates in claim reviews.
Education:
Bachelor’s degree or equivalent experience required. Industry designations preferred, but not required (IIA, AIC, AEI, and/or CPCU)
Knowledge and Skills:
Ability to work independently while assimilating various technical subjects.
Good verbal and written communication skills.
Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
Strong ability to identify, analyze and solve problems.
Effective interpersonal skills to effectively interact with all levels of internal and external clients.
Experience:
Worker’s Comp – Technical claims investigations/settling experience with 3-6 years experience in Broadspire Claims or similar organization.
Workers Compensation (WC) Adjuster License required according to jurisdictional requirements.
Decision Making/Interaction:
Workers’ Compensation
Contacts: Clients, Nurse Case Managers, Vendors, Attorneys, Physicians, Client Service Ddirectors, Service Center Managers, Team Managers, Home Office Claims.
Settlement Authority: $25,000 - $100,000
Direct Reports: None
Indirect Reports: None
Industry Designations: Preferred: IIA, AIC, AEI, and/or CPCU.
License Requirements: Per State or Jurisdictional requirements.
Claim Gravity:
Internal case classification of ‘W” or “X”, although additional classifications may be indicated due to designated staff arrangements with clients. Claims would include coverage or compensability issues, denials, subrogation, higher exposures and more complex issues and injuries. Can include more routine structured settlements and Medicare set-aside issues. The reserve authority level for this position is $100,000.
Special Requirements/Certifications/Requirements:
License Requirements: Per State or Jurisdictional requirements.
In addition to a competitive salary, Crawford offers you:
Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 location in 63 countries
On-going training opportunities through every stage of your career
Strong benefits package including 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/15909307
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Published on May 04, 2010
Viewed: 914 times
Viewed: 914 times
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