What does a claim processor do?

An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud. They collect documents from different organizations, perform field research, and interview witnesses to verify the accuracy of claims statement.

While similarities exist, there are also some differences between claim processors and adjuster. For instance, claim processor responsibilities require skills such as "data entry," "medical terminology," "cpt," and "claims processing." Whereas a adjuster is skilled in "strong customer service," "litigation," "liability claims," and "policy coverage." This is part of what separates the two careers.

An appraiser is someone who assesses the monetary value of a property such as an automobile, real property, and personal claim. His/Her or her responsibilities include resolving disparities between a property's monetary values and preparing narrative reports for projects. The essential skills that an appraiser should possess to accomplish such responsibilities include a keen eye for details, strong communication, analytical, and problem-solving skills, and the ability to work under pressure. The education requirements for the job vary depending on the area of focus.

Each career also uses different skills, according to real claim processor resumes. While claim processor responsibilities can utilize skills like "data entry," "medical terminology," "cpt," and "claims processing," appraisers use skills like "appraisal reports," "mai," "discounted cash flow," and "market research."

A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.

The required skills of the two careers differ considerably. For example, claim processors are more likely to have skills like "claims processing," "medical insurance claims," "provider contracts," and "quality standards." But a reimbursement specialist is more likely to have skills like "patients," "appeals," "medicare," and "patient accounts."

A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.