Claim specialist vs enrollment specialist

Differences between claim specialist and enrollment specialist duties and responsibilities

Claim specialist example responsibilities.

• Assist in the streamlining of EDI process to manage workflow of EDI claims.
• Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
• Manage expedition of appeals via problem solving and collaboration with other departments.
Show more

Enrollment specialist example responsibilities.

• Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
• Manage customer relations with internal personnel, group administrators, brokers and members as related to HMO commercial insurance.
• Maintain records pertaining to eligibility and enrollment by managing CMS reports.
• Provide enrollment counseling to eligible recipients about Medicaid manage care and promote their voluntary enrollment into an HMO.
• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Assist medical assistance consumers with choosing HMO's and PCP as well as with HMO and PCP transfers.
Show more