Appeals examiner vs workers' compensation hearings officer

Differences between appeals examiner and workers' compensation hearings officer duties and responsibilities

Appeals examiner example responsibilities.

• Remain compliant with CMS by complying with TMS regulations and helping achieve ISO certification.
• Exemplify superior and quality customer service; assist providers with appeals via phone, mail, or peer to peer.
• Receive documentary and testimonial evidence and apply pertinent federal and state law to prepare recommend orders deciding appeals.
• Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
• Reconsider determination for disputes between Medicare and Medicaid beneficiaries.

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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