Litigation claim representative vs medical claims examiner

Differences between litigation claim representative and medical claims examiner duties and responsibilities

Litigation claim representative example responsibilities.

• Manage assigned third party administration (TPA) multi-jurisdictional workers' compensation; subrogation recovery claims; assign defense attorney.
• Resolve no-fault disputes in the arbitration forum and court system in accordance with no-fault regulation and laws.
• Guide defense counsel throughout litigation process, securing compliance with corporate objectives and guidelines.
• Assist in depositions and interrogatories of inspectors.
• Review summons and complaints receive from medical providers attorneys.
• Monitor closely and provide directive on every case through litigation till resolution are reached.
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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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