Medical claims analyst vs insurance adjuster

Differences between medical claims analyst and insurance adjuster duties and responsibilities

Medical claims analyst example responsibilities.

• Manage cases by aggressively directing the litigation process.
• Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
• Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
• Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
• Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
• Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.
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Insurance adjuster example responsibilities.

• Achieve targeted performance goals in every aspect to manage costs and support Allstate's industry-leading operational standards.
• Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
• Train in Xactimate estimation and sketch programs.
• Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
• Skil in complex arbitration and mediation negotiations.
• Recommend files for arbitration or litigation base on evidence available and inability to compromise with adverse party.
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