Reinsurance claims analyst vs senior claims specialist

Differences between reinsurance claims analyst and senior claims specialist duties and responsibilities

Reinsurance claims analyst example responsibilities.

• Help managed meetings regarding decision making on CMS regulations.
• Conduct quarterly internal commutations SOX testing.
• Ensure the privacy and security of protect health information per HIPPA requirements
• Confirm general ledger shows all accounting transactions for given period and reconciliations are conduct.
• Request and review documentation and testing in order to qualify patients for Medicare and Medicaid coverage.
• Analyze office administration support for analysts supporting DOD projects to identify efficiency opportunities to prototype and write report of analysis findings.
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Senior claims specialist example responsibilities.

• Manage assigned third party administration (TPA) multi-jurisdictional workers' compensation; subrogation recovery claims; assign defense attorney.
• Work toward settlement with claimants and attorneys, or determine company litigation strategy, participating in mediation and arbitration when necessary.
• Maintain EDI processing table logic.
• Work with testing HIPAA transactions, reporting and processing data reporting to the state.
• Review data entry of claims receive through the EDI system for accuracy prior to processing.
• Operate within all company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.
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