Worker's compensation claims examiner vs adjuster

Differences between worker's compensation claims examiner and adjuster duties and responsibilities

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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Adjuster example responsibilities.

• Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
• Review evidence obtain in liability investigations to evaluate a claim for success in recovery through litigation or arbitration.
• Document measurements and relevant data to author estimates and appraisals utilizing Xactimate 28software.
• Charge with answering and defending policy holders and company interests through independent and binding third-party arbitration proceedings.
• Review departmental reports and financial data; prepare reports of findings, negotiating settlement demands or recommending litigation.
• Prepare computerize estimates utilizing Xactimate and document all activity associate with the claim in clients web base claims management system.
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