Claims reviewer vs customer care representative

Differences between claims reviewer and customer care representative duties and responsibilities

Claims reviewer example responsibilities.

• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Review worker comp claims base on state fee schedule and ICD-9 guidelines.
• Research ICD-9 codes and verify they are equivalent with customer s diagnoses.
• Review accounts per OCC guidelines that all efforts are met and due diligence complete.
• Research claims, review document findings and execute OCC approve harm test for each file.
• Help maintain company compliance with FDA and ICH Regulations/Guidelines governing the reporting of adverse event reports.
Show more

Customer care representative example responsibilities.

• Manage and plan escalations; assure HIPPA guidelines are followed for confidentially and privacy.
• Answer incoming calls from clients, ATP's, therapists, and medical offices.
• Maintain schedules for multiples ATP's and technicians to assist clients with scheduling therapy evaluations, and delivery of equipment.
• Design a web-base CRM tool integrate with many other systems to provide technicians one-page panel the most relevant information and actions.
• Navigate windows environment and comprehend technical information.
• Used multiple navigation windows while changing account information and processing orders.
Show more