Adjudicator vs workers' compensation hearings officer

Differences between adjudicator and workers' compensation hearings officer duties and responsibilities

Adjudicator example responsibilities.

• Manage appeals and authorizations by examining information and performing necessary adjustments.
• Report (Medicaid rejects).
• Identify and resolve deny claims prior to medication delivery, working with nursing facilities, insurance companies and Medicaid.
• Schedule additional investigation to resolve issues and obtain document evidence to support OPM's decision.
• Perform monthly and quarterly QCP and ACA audits.
• Administer oaths, enter evidence into record and make decisions regarding those arrest for DUI.

Workers' compensation hearings officer example responsibilities.

• Manage litigation, pay timely compensation, file necessary state forms timely, negotiate appropriate settlements within company assign authority.
• Read & interpret various facility & physician reports such as AME, QME, IME, etc.
• Review members med/legal PQME and AME reports for applicable industrial evidence.
• Research applicable black letter laws and decisions, write briefs and appear before the WCAB.
• Appear and represent the carrier/insured at WCAB hearings, trials, mediations, arbitrations, and depositions.
• Coordinate and process all workers' compensation and disability benefits claims for large nursing home and rehabilitation center.
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