Claims Specialist - Workers Compensation

Crawford & Company - Livonia, MI

Full-time - Entry Level

Livonia, MI

Insurance Carriers and Related Activities

About the position

This is an early career position focused on administering and resolving non-complex short-term claims, primarily in an office setting. The role involves conducting investigations, verifying policy coverage, and making decisions on claims within a limited authority. The candidate will interact with claimants and medical professionals to ensure proper handling of claims and maintain documentation throughout the process.

Responsibilities

• Conducts investigations of claims to confirm coverage and determine liability, compensability, and damages.
• Works closely with claimants, witnesses, and medical professionals pertinent to the investigation and processing of claims.
• Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves as necessary during the processing of the claim.
• Identifies wage loss expenses and wage exposures on medical claims.
• Documents receipt and contents of medical reports.
• Interacts frequently with claimants to understand the nature and extent of injury and medical conditions.
• Reviews and handles correspondence within authority including material from team members and/or clients.
• Approves payments of medical bills on lost time disability claims within payment authority up to $2,500 after compensability has been determined.
• Evaluates medical claims for potential fraud issues, loss control, and recovery in accordance with insurance policy contracts, medical bill coding rules, and state regulations.
• 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.
• Provides input on the completion of status reports, initiates activity checks and/or widow's statement of dependency forms with team manager's guidance.
• Completes all reporting forms and file documentation.
• Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
• Performs other related duties as required or requested.

Requirements

• College degree or equivalent education and experience.
• Knowledge of claims and familiarity with claims terminology gained through industry experience and/or specialized courses of study (e.g., Associate in Claim designation).
• Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level.
• 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.

Benefits

• Generous Employee Benefits
• Multiple Employee Discounts
• 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
• Sustainability programs that give back to the communities in which we live and work
• A culture of respect, collaboration, entrepreneurial spirit, and inclusion