Home office claims examiner vs senior claims processor

Differences between home office claims examiner and senior claims 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.

Senior claims processor example responsibilities.

• Manage confidential medical records and directs them to the appropriate practitioners while ensuring HIPPA regulations are maintain.
• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Process CalPERS HMO facility claims.
• Experience with HMO's, IPA's and insurance authorizations.
• Handle confidential information according to new laws (HIPPA).
• Review ICD-9 diagnosis codes against CPT codes for claim payment guidelines.
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