Medical Claim Analyst

US-TX-Dallas
2 weeks ago
Requisition ID
2017-2211
Category
Claims
Business Unit
Broadspire

Excellence In Everything We Touch

Broadspire Claims

Position Summary

Under direct supervision, processes medical only claims within authority, processes other claims open only for the administration of medical benefits (i.e. maintenance claims without actuarial reserves); approves payments and claimant reimbursements on lost time disability claims, within authority, after compensability has been determined.    

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, initiate’s 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.

Requirements

  • 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. 

About Us

Broadspire (www.choosebroadspire.com), a leading international third party administrator, provides risk management solutions designed to help clients improve their financial results. Broadspire offers casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics. As a Crawford Company, Broadspire is based Atlanta, Ga., with 85 locations throughout the United States. Services are offered by Crawford & Company under the Broadspire brand in Europe (www.Broadspire.eu), including the United Kingdom (www.BroadspireTPA.co.uk).

In addition to a competitive salary, Crawford offers you:

  • Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries;
  • On-going training opportunities through every stage of your career
  • Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.

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. 

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