Claims benefit specialist vs adjuster

Differences between claims benefit specialist and adjuster duties and responsibilities

Claims benefit specialist example responsibilities.

• Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
• Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
• Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
• Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
• Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
• Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.
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Adjuster example responsibilities.

• Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
• Review evidence obtain in liability investigations to evaluate a claim for success in recovery through litigation or arbitration.
• Document measurements and relevant data to author estimates and appraisals utilizing Xactimate 28software.
• Charge with answering and defending policy holders and company interests through independent and binding third-party arbitration proceedings.
• Review departmental reports and financial data; prepare reports of findings, negotiating settlement demands or recommending litigation.
• Prepare computerize estimates utilizing Xactimate and document all activity associate with the claim in clients web base claims management system.
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