Claim approver vs senior claims representative

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

• Conduct detailed interviews with physicians, prepare comprehensive written reports, retain defense counsel, and effectively manage the litigation process.
• Utilize Xactimate estimating system during field inspection to properly evaluate commercial property damages.
• Update computer generate claim file (s) with medical diagnoses, current CPT and ICD codes.
• Analyze claims using IDC and CPT coding and negotiate settlements with attorneys, claimants, medical providers, and insureds.
• Set up independent medical examinations, issue denials, attend arbitration hearings.
• Coordinate and attend various mediation and arbitration hearings as well as numerous settlement hearings and conferences.
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