Worker's compensation claims examiner vs claim processor

Differences between worker's compensation claims examiner and claim processor 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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Claim processor example responsibilities.

• Experience in many facets of the managed healthcare insurance business.
• Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
• Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
• Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
• Call DME and HME companies to correct invoices.
• Coach and assist in the training of new EMR databases.
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