Claims Specialist- Liab

Claims Specialist
- Liab (Finance)

• College degree or the equivalent education and experience.
• Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc).
• 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 have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level. Must possess a valid driver’s license. Must complete continuing education requirements as outlined by Crawford Educational Services. Additional courses may be required by jurisdiction for maintenance of license.

• Conduct investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims.
• Verify policy coverage for submitted claims and notify the insured of any issues; determine and establish reserve requirements, adjusting reserves within designed authority as necessary, during the processing of the claim.
• Identify applicable wage loss expenses and wage exposures.
• Document receipt and contents of claim documents including medical reports, police reports, etc. Interact frequently with claimant to understand nature and extent of injury and medical conditions. Review and handle other correspondence within authority including material from team members and/or clients.
• Approve payments within scope of payment authority.
• Evaluate claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations.
• Keep Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refer matters beyond limits of authority and expertise to Team Manager for direction.
• With the team manager’s guidance, provide input on the completion of status reports, initiate activity checks and/or widow’s statement of dependency forms.
• Complete all reporting forms and file documentation.
• Adhere to client and carrier guidelines and prepare written updates for supervisor to review.
• Develop subrogation/third party recovery potential and follow recovery procedures.
• Participate in claim reviews as applicable.
• Perform other related duties as required or requested.