Worker's compensation claims examiner vs claims analyst

Differences between worker's compensation claims examiner and claims analyst 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.
Show more

Claims analyst example responsibilities.

• Help managed meetings regarding decision making on CMS regulations.
• Process UB's and HCFA's according to guidelines.
• Analyze and investigate medical claims utilizing ICD-9 and CPT-4 coding.
• Review claims (HCFA and UB) for accurate billing submission.
• Interpret medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes for member submit claims.
• Acquire biometrics and perform phlebotomy.
Show more