Home office claims examiner vs claim processor

Differences between home office claims examiner and claim processor duties and responsibilities

Home office claims examiner example responsibilities.

• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Review and approve new applications in accordance to CIP guidelines.
• Provide technical support and direction as to case management, experts, litigation management and final authority on reportable claims.
• Participate in business process redesign in claims and litigation.
• Provide oversight for quarterly system testing ensuring system integrity are not compromise by directing consistent testing practices across multiple groups.
• Negotiate settlements and file arbitration or hire counsel when warrant.

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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