Claim approver vs liability claims representative

Differences between claim approver and liability claims representative duties and responsibilities

Claim approver example responsibilities.

• Manage confidential medical records and directs them to the appropriate practitioners while ensuring HIPPA regulations are maintain.
• Train new hires on HMO claim processing.
• Provide claim processing information for medical indemnity and PPO plans.
• Present clinical management appeals for physician review and prepare provider resolution correspondence.
• Submit appeals insurance follow-ups electronically, no fault, and workers compensation insurance.
• Direct litigation in the areas of environmental liability, extra contractual claims, general liability, and medical malpractice.
Show more

Liability claims representative example responsibilities.

• Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
• Investigate and conclude property and casualty liability claims including those in litigation with the highest overall production of the claims representatives.
• Participate in arbitration hearings through writing contentions, compiling evidence and personally representing files.
• Control expenses by developing and following resolutions and/or litigation plans to drive claim to resolution.
• Facilitate training seminars for new employees to familiarize them with various corporate procedures including exposure recognition, fraud detection and arbitration.
• Complete field inspection of losses including accurate scope of damages, photographic evidence collection, written estimates utilizing Xactimate estimating software.
Show more