Claim processing specialist vs customer service specialist

Differences between claim processing specialist and customer service specialist duties and responsibilities

Claim processing specialist example responsibilities.

• Manage expedition of appeals via problem solving and collaboration with other departments.
• Provide consumer-oriented health benefit plans, process all types of health claims knowledgeable of ICD-9 and CPT codes.
• Process medical claims for Medicaid recipients via a state-fund Medicaid insurance carrier per plan guidelines and department procedures.
• Ensure all work processes are compliant with various HIPAA regulations.
• Train on how to utilize reference materials to determine diagnosis, CPT, or appropriate HCPCS codes for claims processing.
• Provide speeches, educational information to various veterans organizations.
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Customer service specialist example responsibilities.

• Work with customers/companies over the phone and helps troubleshoot technology/service issues while maintaining customer satisfaction in a large call-center capacity.
• Mentore the team members and QA team for timely releases.
• Monitor reports, compile reviews, and participate in QA calibrations.
• Oversee management of social networking presence on Facebook, various travel relate blogs and utilizing various social listening tools.
• Provide exceptional customer service to customers regarding MetLife products
• Create PowerPoint presentations for forecasting of inventory requirements and overall changes in customer order volume.
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