Remote Adjudication Jobs in Georgia (NOW HIRING)

Why Crawford?

Because a claim is more than a number - it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time.

At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We're looking for the next generation of leaders to take this journey with us.

We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.

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 Program

*The 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.

• Bachelor's degree or equivalent experience required.
• 2 + years of STD/LTD claims adjudication
• Experienced in the TPA or self-administration services is desired
• Experience with FMLA/State leave claims is a plus
• Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
• Ability to work independently while assimilating various technical resources
• Computer knowledge in excel, word, web based systems, etc
• Good verbal and written communication skills
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
• Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
• Strong ability to identify, analyze and solve problems.
• Effective interpersonal skills capable of dealing with external sources and all levels of employees.

#LI-DV1

• Manages assigned caseload of disability claims for Short Term/Long Term Disability.
• Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
• Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
• Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
• Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
• Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
• Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards
• Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.
• Analyzes claims activity and prepares reports for clients/carriers and management as needed
• Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.
• Effectively works together in a team setting.
• Other duties as assigned.