Claims vice president vs claim processor

Differences between claims vice president and claim processor duties and responsibilities

Claims vice president example responsibilities.

• Retain and manage outside counsel; develop and coordinate strategy for litigation; participate in alternative dispute resolution and negotiate settlements.
• Provide management oversight of client support at offices in Indiana, Kentucky and Ohio.
• Provide vision, oversight and direction to claims and encounter processing and claims systems configuration.
• Work with underwriting carrier to ensure that all TPA responsibilities are being handle according to the TPA guidelines.
• Establish and direct internal and external performance standards and procedures for use with TPA's or general agents.
• Negotiate claims litigation, including settling lawsuits via mediation strategies.
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Claim processor example responsibilities.

• Experience in many facets of the managed healthcare insurance business.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
• Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
• Call DME and HME companies to correct invoices.
• Coach and assist in the training of new EMR databases.
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