Senior claims processor vs claim specialist

Differences between senior claims processor and claim specialist duties and responsibilities

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.
Show more

Claim specialist example responsibilities.

• Assist in the streamlining of EDI process to manage workflow of EDI claims.
• Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
• Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
• Manage expedition of appeals via problem solving and collaboration with other departments.
Show more