Worker's compensation claims examiner vs claims representative

Differences between worker's compensation claims examiner and claims representative 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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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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