Senior claims examiner vs worker's compensation claims examiner

Differences between senior claims examiner and worker's compensation claims examiner 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

Worker's compensation claims examiner example responsibilities.

• Manage all aspects of claims, including heavy litigation and vocational rehabilitation cases.
• Negotiate settlements and actively manage the litigation process and process complex and technically difficult claims.
• Determine benefits when processing medical claims receive as HCFA and UB92 paper claims or electronically.
• Set up vehicle inspections, and rental reservations as a part of the claim settlement process.
• Handle incoming calls from customers and providers with policy changes and claim status updates and maintain HIPAA.
• Process claim forms, adjudicates for provision of deductibles, co-pays, co-insurance maximums and provider settlements and Medicaid claims.
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