Senior claims processor vs claims representative

Differences between senior claims processor and claims representative 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.
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Claims representative example responsibilities.

• Perform initial set-up and continuously manage claims in the Juris claims management system.
• Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
• Prepare necessary state filings within statutory limits, manage litigation and vocational rehabilitation process, used appropriate cost containment techniques.
• Assist the training department in developing CSR training in order to set expectations.
• Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
• Utilize proper SIU reporting procedures for extensive investigation as required.
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