Claims Representative Responsibilities and Duties

Posted in Job Responsibilities

Maintain technical knowledge and evaluate all claims and facilitate reduction in loss ratio and investigate all losses and prepare required information.

Perform interviews with all claimants and medical specialists.

Gather all required information for claims, record statements and prepare all medical reports and evaluate all benefits for set reserves.

Verify all claims and charges for medical providers.

Analyze all claims and deny coverage if required and settle all claims according to authority and identify all potential issues in claims and perform research on same to resolve it effectively.

Coordinate with claim department and resolve any special issues.

Administer receivables for all claim department through determine workflow and ensure compliance to all state regulations.

Collaborate with higher technical claim personnel and ensure handling of files properly and evaluate all loss for claims and initiate procedures to facilitate recovery.

Manage all claim files for residual periods and ensure accuracy in same and monitor all payment and denial of claims and coordinate with manager for same.

Coordinate with health and repair facility and perform all necessary report and notify all underwriting for any risk and ensure accuracy in all code data.

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