Senior claims examiner vs senior claims processor

Differences between senior claims examiner and senior claims processor duties and responsibilities

Senior claims examiner example responsibilities.

• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate vendor referrals for additional investigation and/or litigation management
• Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
• Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
• Coordinate vendor referrals for additional investigation and/or litigation management

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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