Claims reviewer vs member service representative

Differences between claims reviewer and member 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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Member service representative example responsibilities.

• Coordinate and manage ATM and automate telephone services.
• Identify cross-sell opportunities; actively and aggressively promote products to achieve credit union target production expectations.
• Utilize federal and state Medicaid health guidelines to implement proper manage care according to departmental policies and procedures.
• Educate veterans and the college community on veteran's benefits and academic requirements need to accomplish academic goals.
• Open different accounts base on customer needs, from basic checking and savings, to IRAs, Cds, etc.
• Train in CPR and other emergency procedures.
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