Claims vice president vs health claims examiner

Differences between claims vice president and health claims examiner 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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Health claims examiner example responsibilities.

• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Review and analyze medical claims to finalize payments according to Medicaid benefits.
• Analyze and process Medicare and Medicaid claims (Primary/Secondary).
• Blood collection by venipuncture and capillary technique ensure all specimens are collect accurately, on time and according to establish procedures.
• Coordinate vendor referrals for additional investigation and/or litigation management