Claims reviewer vs customer service representative

Differences between claims reviewer and customer service 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.
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Customer service representative example responsibilities.

• Manage and plan escalations; assure HIPPA guidelines are followed for confidentially and privacy.
• Maintain cleanliness and safety and assist patients as necessary.
• Operate POS system and maintain exceptional and consistent customer service.
• Exercise proofreading and basic math skills to maintain quality control over documents process
• Work in customer service department entering information into customer relationship management (CRM).
• Develop highly empathetic client relationships and earn reputation for exceeding good customer service rep goals.
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