Claims benefit specialist vs insurance adjuster

Differences between claims benefit specialist and insurance 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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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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