Claim approver vs senior claims examiner

Differences between claim approver and senior claims examiner 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.
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Senior claims examiner example responsibilities.

• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate vendor referrals for additional investigation and/or litigation management
• Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
• Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
• Coordinate vendor referrals for additional investigation and/or litigation management