Claims director vs claims supervisor

Differences between claims director and claims supervisor duties and responsibilities

Claims director example responsibilities.

• Create project team that comply with new Medicare reporting requirements achieving successful reporting to CMS.
• Maintain relationships with attorneys and manage litigation strategy; ensure strong relationships with insureds, brokers and third party administrators.
• Redesign processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.
• General knowledge of CPT, ICD-9, HCPCS, DRG and Medicode (UCR), bundling and unbundling.
• File and respond to online arbitration matters.
• Facilitate annual updates to all new and revise CPT codes assuring accurate claims payment.
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Claims supervisor example responsibilities.

• Manage, train and continuously develop a team consisting of both inside SIU investigators and field investigators.
• Apply fundamentals of insurance investigation and resolution to an introductory leadership role managing complex claim files and tort litigation files.
• Make determinations to authorize payments via XACTIMATE software.
• Assist TPA in obtaining company documentation and scheduling employee interviews in investigation of claims.
• Advise physician on any changes with CPT and ICD-9 coding to maximize reimbursements and minimize denials.
• Provide oversight and direction for highly complicate claim reviews base on policy, procedure and CMS guidelines.
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