Claims Specialist-WC

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule)." It's examples, not exclusive. We can use other headings if appropriate? It says use h3 for section headings (e.g. About the role, Responsibilities...). Likely they expect those headings only. But we can still include "About Us" as a heading? Might be considered not matching the list but still a section heading. Safer to follow examples: we could rename "About Us" to "About the role" if content fits? The content is about Crawford company, not role. Could still be "About the role"? Not accurate. Maybe we should omit "About Us" because it's not required? But we need to preserve ALL substantive information. The "About Us" paragraph is substantive. We could put it under a heading like "About the role" but that would be misleading. However instruction says "include a section ONLY when the posting has real, specific content for it — never emit a heading followed by filler/placeholder text". It doesn't forbid using other headings besides the examples; they just gave examples. So we can use "About Us" as heading. - Then "Education" heading? Actually there is a subheading "Education" under benefits? Actually after "About Us" there is "Education" then bullet list of benefits? Wait: The text: "Education When you accept a job with Crawford, you become a part of the One Crawford family. And as part of the One Crawford family, we offer a comprehensive Total Rewards package to our employees to assist with their financial, health/wellness, continuing education/training and other needs: Competitive base pay - The Pay Range/Salary represents the anticipated low and high pay that may be offered for this position. To determine the actual offer, Crawford considers a wide range of factors including the candidate’s previous experience and education, market rates, minimum pay requirements for the applicable jurisdiction, business segment, supply/demand, and scheduled hours. Bonus/Incentive Pay and other Performance-Based Rewards, if applicable.We offer a well-rounded benefits package that encourages wellness and helps our employees to be an educated healthcare consumer. The core benefits* offered include: - 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 Other Benefits currently available at no cost include: - Enhanced Mental Health Support Virtual Physical Therapy Caregiving Services Life Assistance ProgramThe above information highlights some of the benefits currently available to eligible full-time employees.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. Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means." We need to remove boilerplate: EEO, E-Verify, search firm disclaimer, etc. Also remove duplicated lines. Keep substantive info: benefits description, pay range mention, bonus/incentive, etc. We need to decide sections: Possibly "Benefits", "Pay", maybe "Schedule" not present. No schedule info. So we omit Schedule. We have "Education" heading but actually it's part of benefits description; maybe we treat "Education" as a subsection? But we can just include benefits under "Benefits". The paragraph starts with "Education When you accept a job..." but it's not about education requirement; it's about total rewards. So we could treat that as "Benefits". We'll extract benefits list. Also there is mention of "Competitive base pay - The Pay Range/Salary represents the anticipated low and high pay that may be offered for this position." That's pay info, though not specific numbers. We should include Pay section only if posting actually states them. It states there is a pay range but not numbers. Is that considered substantive? It says "Competitive base pay - The Pay Range/Salary represents the anticipated low and high pay that may be offered for this position." That's still some info about pay range existing. It's not filler like "not specified". It says there is a range. So we can include Pay section with that sentence. We also have "Bonus/Incentive Pay and other Performance-Based Rewards, if applicable." That's also pay-related. We also have training programs, sustainability programs, culture. We could put those under "Benefits" or maybe separate "Training & Development". But instruction only lists certain headings; we can add others if needed. But to keep simple, we can put all that under Benefits. We must not include sections with filler like "commensurate with experience". We have none. Now we need to strip out boilerplate: EEO, E-Verify, search firm disclaimer, also "Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V" and the search firm paragraph. Also remove "Learn more at www.crawco.com". Also remove "Education" heading? Actually we might keep "Education" as a heading if we want to separate education requirement? But there is no education requirement separate; qualifications already include college degree. So we can drop the "Education" heading that precedes benefits; it's just a lead-in. Thus final HTML:

About the role

Ready to make a real impact? We're looking for a sharp, proactive Claims Specialist - WC to join our team! In This Role, You'll Manage and resolve straightforward, short-term Workers' Compensation claims, including medical-only cases; Keep claims moving through accurate documentation and timely follow-through; Exercise sound judgment when making decisions within delegated authority; Deliver accuracy, efficiency, and exceptional service on every claim. If you're detail-oriented, organized, and ready to grow in a fast-paced environment, we'd love to hear from you!

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, 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 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 of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $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.
• With the team managers guidance, provides input on the completion of status reports, initiate's 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.
• Performs other related duties as required or requested.

Qualifications

• College degree or the equivalent of 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.