Gbsc - Medical Claims Analyst

SummaryThe Medical Claims Analyst is responsible for processing medical only claims and claims open for administration of medical benefits. This role approves payments and claimant reimbursements on medical only claims after compensability has been determined. Job Scope Processes medical only claims within area of payment authority up to $3,500. Processes other claims only open for payment of medical benefits or long term indemnity benefits. Contacts insureds, claimants, and medical providers for additional information to verify and report the status of claims. Approves payments of medical bills on lost time disability claims, after compensability has been determined. Documents receipt and contents of medical reports. Informs Team Manager of all workers' compensation claims to be removed from the M Case classification per Claim Best Practice Guidelines. Reviews and handles correspondence within authority. Provides input on the completion of status reports, initiates activity checks and/or widow's statement of dependency forms. Performs other duties as assigned. Upholds the Crawford Code of Conduct. Functional Knowledge Four-year college (Bachelor's Degree), or at least two years in tertiary level with at least two years experience in the BPO industry Two years of experience working as a Claim Clerk or other closely related role. Adjuster license, preferred but not required Working knowledge of claim processing and claim policies and procedures. Good understanding of basic medical terminology and appropriate medical tests for claimed conditions. Good written and verbal communication skills. Ability to identify and understand customer needs and interacts effectively with others.