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There is currently no job description for Account Claims Representative, be the first to
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the job responsibilities for Account Claims Representative.
The Patient Claims Supervisor coordinates activities and delegates workflow to ensure timely billing and claims processing. Supervises the administration of patient accounts and ensures record keeping practices comply with industry regulations and operational standards. Being a Patient Claims Supervisor researches and resolves patient inquiries involving account charges, insurance payments, and balances. Verifies payment sources and insurance policies and submits claims and required documentation to the appropriate third-party payers. In addition, Patient Claims Supervisor produces account summaries detailing total charges for services, payments received and adjustments made, account balance, and payment due date. May require a bachelor's degree. Typically reports to a manager. The Patient Claims Supervisor supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Working as a Patient Claims Supervisor typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision.
Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to a director. The Claims Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes.
Claims Quality Audit Manager manages the claims quality auditors and daily activities of quality claims audit function. Reviews and tracks claims quality audit reports and measures performance of auditors. Being a Claims Quality Audit Manager provides assistance in developing claims audit policies and procedures. May provide coaching in complex claims audit. Additionally, Claims Quality Audit Manager typically requires a bachelor's degree. Typically reports to a director or head of a department. The Claims Quality Audit Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Quality Audit Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes.