Claims Specialist- Liab

Responsibilities

• Conducts 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.
• Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves within designed authority, as necessary, during the processing of the claim.
• Identifies applicable wage loss expenses and wage exposures.
• Documents receipt and contents of claim documents including medical reports, police reports etc. Interacts frequently with claimant to understand nature and extent of injury and medical conditions.
• Reviews and handles other correspondence within authority including material from the team members, and/or clients.
• Approves payments within scope of payment authority.
• Evaluates 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.
• With the team managers' guidance, provides input on the completion of status reports, initiates activity checks and/or widow’s statement of dependency forms.
• Completes all reporting forms and file documentation.
• Adheres to client and carrier guidelines and prepares written updates for supervisor to review.
• Develops subrogation/third party recovery potential and follows recovery procedures.
• Participates in claim reviews as applicable.
• Performs other related duties as required or requested.

Qualifications

• 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).
• Athorough working knowledge of claim processing and claim policies and procedures.
• An understanding of basic medical terminology and appropriate medical tests for claimed conditions.
• Effective and diplomatic oral and written communication skills.
• 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.