Worker's compensation claims examiner vs senior claims analyst

Differences between worker's compensation claims examiner and senior 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.
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Senior claims analyst example responsibilities.

• Accomplish facets and Macess user including running reports.
• Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
• Coordinate the maintenance of TPA payment type / code table conversions data.
• Process claims, generate checks, create reports and correspond with TPA clients.
• Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
• Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.
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