[Hiring] Medical Claim Analyst @Crawford & Company

Role Description

Step into a role where precision meets purpose. As a Medical Claim Analyst, you’ll manage medical-only and maintenance claims under direct supervision, ensuring seamless administration of medical benefits. You’ll also review and approve payments and claimant reimbursements for lost-time disability claims (within authority) once compensability is established. This fully remote opportunity is perfect for detail-oriented professionals ready to grow their claims expertise while making a real impact every day.

If you're looking to expand your claims experience while working from the comfort of your home, we'd love to hear from you!

Responsibilities

• Processes "M" Case claims (medical only) within area of payment authority up to, but not exceeding $3,500.
• 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, 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, initiates activity checks and/or widow's statement of dependency forms.
• Performs other related duties as required or requested.
• Upholds the Crawford Code of Business Conduct at all times.
• Participates in special projects or performs duties in other areas as requested.

Qualifications

• College degree or the equivalent education and experience.
• Two or more years of experience as a Claim Clerk or the equivalent, demonstrating a thorough knowledge of computer entry and operations.
• Demonstrates a thorough working knowledge of claim processing and claim policies and procedures.
• Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions.
• Demonstrates effective and diplomatic oral and written communication skills.
• Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others.
• Must be licensed as required by state and local jurisdictions. Must complete designated continuing education courses while in position in order to advance.

Benefits

• Competitive base pay.
• Bonus/Incentive Pay and other Performance-Based Rewards, if applicable.
• Medical, Dental and Vision Plans.
• Prescription Drugs.
• 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 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.