Claims Managers Sample Clauses

Claims Managers. Supervisors, Adjusters and Assistants assigned to handle City cases will meet the minimum experience and certification requirements set for in Contractor’s response to the City’s RFP which is attached hereto and incorporated by reference as if fully set forth herein. Any temporary claims adjusters must meet the minimum experience qualifications set forth in section 2.2, above. Only experience handling cases under the California Labor Code will be counted toward meeting the experience requirements. Claims examiners shall be responsible for handling all indemnity cases. Average caseloads for each of Contractor's Senior Claims Adjusters and Claims Adjusters assigned to WCD claims shall not exceed 135 open active indemnity claims except when an adjuster is dedicated to a department and CCSF is aware of the caseload. In that situation, that adjuster’s caseload will not exceed 160 cases. Contractor shall not alter adjuster staffing based upon fluctuations in caseloads without the prior written approval of the Deputy Director of Workers’ Compensation or his designee. If WCD claims caseload exceeds 135 open active indemnity claims for 90 consecutive days (with the above exception), the parties shall meet and confer within 30 days thereafter to establish a plan to reduce adjuster caseload below the 135 claim threshold. Such a plan may include adjustments to the Calculation of Charges should FTEs in addition to those listed in Section 2.0 of this Appendix be deemed necessary by the parties. Performance of claims examiners will meet the standards set forth the in the Client Service Instructions..
Sample 1
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Related to Claims Managers

  • Claims Administrator A. The Human Resources Director through his/her designated Claims Administrators shall administer the provision of this policy. The City Physician shall provide the City's Claims Administrators with all available medical information concerning the Employee's injury and/or medical opinions as requested. Medical information and opinions shall be based upon the Employee's medical records and/or physical examination. Questions of Employee eligibility shall be determined by the provisions established under State Statute 49-110, 49-111 and Oklahoma Worker's Compensation Title 85. Prior to any denial of injury leave benefits where lost time actually occurred, the administrator shall notify Union and allow a Union representative the opportunity to review the application pending denial and provide any additional information relating to same as may be necessary. Should the City change designated Claims Administrators Local 176 will be notified in writing.

  • Claims Administration An employee will be required to comply with any and all rules and regulations and/or limitations established by the carrier or applicable third party administrator and contained in the policy, and employees and their dependents shall look solely to such carrier or third party administration for the adjudication of the payment of any and all benefits claims.

  • Claims Submission We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

  • Appeals Committee ‌ An Appeals Committee is hereby established composed of one member appointed by the Union, one member appointed by the Employer or by the Association, as the case may be, and a Public Member appointed by both these members.

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Grievance Committee The Hospital will recognize a Grievance Committee composed of the Chief Xxxxxxx and not more than (as set out in Local Provisions Appendix) employees selected by the Union who have completed their probationary period. A general representative of the Union may be present at any meeting of the Committee. The purpose of the Committee is to deal with complaints or grievances as set out in this Collective Agreement. The Union shall keep the Hospital notified in writing of the names of the members of the Grievance Committee appointed or selected under this Article as well as the effective date of their respective appointments. A Committee member shall suffer no loss of earnings for time spent during their regular scheduled working hours in attending grievance meetings with the Hospital up to, but not including arbitration. The number of employees on the Grievance Committee shall be determined locally.

  • Claims Review The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.

  • Post Service Claims In the case of a Post-Service Claim, CareFirst BlueChoice shall notify the Member of the CareFirst BlueChoice’s Adverse Benefit Determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be extended one time by CareFirst BlueChoice for up to 15 days, provided that CareFirst BlueChoice both determines that such an extension is necessary due to matters beyond the control of CareFirst BlueChoice and notifies the Member, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which CareFirst BlueChoice expects to render a decision. If such an extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Member shall be afforded at least 45 days from receipt of the notice within which to provide the specified information.

  • Review Committee A Student may ask that the decision of the Housing Director or designee to deny the cancellation be reviewed. The review will be conducted by a committee consisting of University officials.

  • Claims Review Findings a. Narrative Results.‌‌

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