Claims reviewer vs service representative

Differences between claims reviewer and 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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Service representative example responsibilities.

• Utilize QuickBooks to manage patient's payment for hearing aids and various equipment.
• Join online marketplace specializing in local deals to manage customer engagements while providing industry-best service.
• Manage customer relations with internal personnel, group administrators, brokers and members as related to Medicare insurance.
• Involve great interpersonal skills and upselling.
• Provide excellent customer service via ZenDesk e-mail platform.
• Counsele individuals who are applying for or receiving TANF.
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