Claims representative vs claims supervisor

Differences between claims representative and claims supervisor duties and responsibilities

Claims representative example responsibilities.

• Perform initial set-up and continuously manage claims in the Juris claims management system.
• Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
• Prepare necessary state filings within statutory limits, manage litigation and vocational rehabilitation process, used appropriate cost containment techniques.
• Assist the training department in developing CSR training in order to set expectations.
• Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
• Utilize proper SIU reporting procedures for extensive investigation as required.
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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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