Claim approver vs senior claims analyst

Differences between claim approver and senior claims analyst 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

Senior claims analyst example responsibilities.

• Accomplish facets and Macess user including running reports.
• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate the maintenance of TPA payment type / code table conversions data.
• Process claims, generate checks, create reports and correspond with TPA clients.
• Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
• Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.
Show more