Worker's compensation claims examiner vs senior claims representative

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

• Conduct detailed interviews with physicians, prepare comprehensive written reports, retain defense counsel, and effectively manage the litigation process.
• Utilize Xactimate estimating system during field inspection to properly evaluate commercial property damages.
• Update computer generate claim file (s) with medical diagnoses, current CPT and ICD codes.
• Analyze claims using IDC and CPT coding and negotiate settlements with attorneys, claimants, medical providers, and insureds.
• Set up independent medical examinations, issue denials, attend arbitration hearings.
• Coordinate and attend various mediation and arbitration hearings as well as numerous settlement hearings and conferences.
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