Claim processor vs insurance adjuster

Differences between claim processor and insurance adjuster duties and responsibilities

Claim processor example responsibilities.

• Experience in many facets of the managed healthcare insurance business.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
• Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
• Call DME and HME companies to correct invoices.
• Coach and assist in the training of new EMR databases.
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Insurance adjuster example responsibilities.

• Achieve targeted performance goals in every aspect to manage costs and support Allstate's industry-leading operational standards.
• Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
• Train in Xactimate estimation and sketch programs.
• Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
• Skil in complex arbitration and mediation negotiations.
• Recommend files for arbitration or litigation base on evidence available and inability to compromise with adverse party.
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