Claims Examiner definition

Claims Examiner has the meaning defined in Section 4.1(1);
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Claims Examiner means anyone who has primary responsibility for decision making or benefit determination in a claim. This would include those who decide compensability of new claims or aggravations, calculate benefits, authorize payments, or who represent employers by direct contact with the Department or Board. This definition does not include attorneys representing employers before the Department or Board, or those who primarily perform clerical functions.
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Claims Examiner means staff employed by Zenith to process claims.
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Examples of Claims Examiner in a sentence

  • In any event, notwithstanding anything to the contrary contained in this Article 12, if the Claims Examiner has not issued its decision within thirty (30) Days of the Detailed Claim being filed, that Claim shall be subject to appeal and submitted to non-binding mediation all as set forth below.

  • Claims for services that are identified by the Claims Examiner as potentially not being Medically Necessary are submitted to the Claims Supervisor for review.

  • Telephone conferences conducted by a Senior Claims Examiner are often held in cases involving complicated adjudicatory and case management issues.

  • The Senior Claims Examiner then makes findings on the issue for resolution and issues a decision.

  • A representative of the employing agency may be asked to participate in such a conference, either with the Senior Claims Examiner alone or together with other parties to the claim.

  • After the conference, the Senior Claims Examiner completes a Memorandum of Conference which describes what each party said, then asks the participant(s) to provide any comments on this document within 15 days (except that comments are not requested if the decision is found in favor of the party conferenced).

  • EXPERIENCE: Unemployment Insurance Examiner 11 Two years of experience equivalent to an Unemployment Claims Interviewer E10 or one year equivalent to an Unemployment Insurance Examiner E10, Unemployment Claims Examiner E10, or Unemployment Claims Interviewer 11.

  • Outreach attempts to obtain information are made by reimbursement services.Procedure/InterventionsA Claims Examiner or Utilization Management designee identifies a need for retrospective review.

  • When more detailed information is needed, the Claims Examiner responsible for the case file can often satisfy the inquiry.

  • Perez is a former OWCP DFEC Claims Examiner and currently practices law.


More Definitions of Claims Examiner

Claims Examiner means Simone Lelchuck and Jed Melnick of Melnick ADR, LLP.
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Claims Examiner means Jeffrey H. Beck, who was appointed as an independent fiduciary, entitled to his own attorney client privilege with his counsel, by the Court pursuant to that certain Order dated October 29, 2007, granting the motion to approve the SunTrust Settlement Agreement, pursuant to which he has full authority to (a) review and investigate Claims against the bankruptcy estate of either AMCAP or TFC Filed by an Insider of either AMCAP or TFC, or an Affiliate of such Insider and (b) review and negotiate the terms of the Plan.
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Claims Examiner means an individual who, as a paid employee of the department, of a plan No. 1, 2, or 3 insurer, or of an administrator licensed under Title 33, chapter 17, examines claims under chapter 71 to:
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Claims Examiner means staff employed by Zenith to process claims. They may review Treatment Requests for the purpose of rendering coverage determinations or application of prior determinations. Claims Examiners may not make medical necessity determinations including decisions to Certify, Non-Certify, delay, or modify a Treatment Request.
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Claims Examiner means non-clinical personnel employed by Zenith to process claims. They do not perform any aspect of Utilization Review, in compliance with
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Claims Examiner means a claims examiner as defined under 39-71-116,
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Related to Claims Examiner

  • Contractor Related Parties means any affliates of the Contractor and the Contractor's executive officers, Pennsylvania officers and directors, or owners of 5 percent or more interest in the Contractor.

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Claims-made coverage means an insurance contract or provision limiting

  • Emergency medical condition means a medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:

  • Group Grievance is defined as a single grievance, signed by a Xxxxxxx or a Union Representative on behalf of a group of employee who have the same complaint. Such grievances must be dealt with at successive stages of the Grievance Procedure commencing with Step 1. The grievors shall be listed on the grievance form.

  • Shared Policies means all Policies, current or past, which are owned or maintained by or on behalf of D&B or any of its Subsidiaries which relate to one or more of the D&B Business, the Cognizant Business or the ACNielsen Business.