Claims reviewer vs customer service specialist

Differences between claims reviewer and customer service specialist 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 specialist example responsibilities.

• Work with customers/companies over the phone and helps troubleshoot technology/service issues while maintaining customer satisfaction in a large call-center capacity.
• Mentore the team members and QA team for timely releases.
• Monitor reports, compile reviews, and participate in QA calibrations.
• Oversee management of social networking presence on Facebook, various travel relate blogs and utilizing various social listening tools.
• Provide exceptional customer service to customers regarding MetLife products
• Create PowerPoint presentations for forecasting of inventory requirements and overall changes in customer order volume.
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