Liability claims examiner vs medical claims examiner

Differences between liability claims examiner and medical claims examiner duties and responsibilities

Liability claims examiner example responsibilities.

• Handle automobile liability, general liability, products liability and manage litigation for one specific client.
• Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
• Oversee adjustment of all third-party liability losses, coverage assessment, investigation, and evaluations regarding litigation claims.
• Mentore less experience and newer employees in career development and individual development plans to facilitate future leadership candidates for the enterprise.
• Interact with assign counsel for case status, interrogatories and preparation for trials on calendar.
• Investigate and identify fraud claims and partner with SIU for additional investigations to prevent payouts after fraud are proven.
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Medical claims examiner example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
• Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
• Identify which claims are eligible for PPO reprising.
• Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
• Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.
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