Senior claims specialist vs claims representative

Differences between senior claims specialist and claims representative duties and responsibilities

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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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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