Claims Administrator Clause Samples

Claims Administrator. A. AHM will self-administer the Settlement as the Claims Administrator. B. The Claims Administrator will be responsible for implementing and administering reimbursement claims by Class Members, including, but not limited to, the following tasks: (1) Receive and conduct an initial validation screening of Claims to determine timeliness of submission, completeness of the Claim, and the completeness of the Required Documentation; (2) Perform Claim Processing and issue payments for Claims; and (3) Collect and transmit to Class Counsel and Defendant’s Counsel the names and contact information of Class Members who “opt out” of the proposed Settlement or object to the proposed settlement. C. Class Members who submit Claims under Paragraphs III(A) herein that are incomplete (e.g. lack Required Documentation other required information) or are not approved for payment will promptly receive from the Claims Administrator by first class mail a written explanation explaining why a Claim has been denied, or, if applicable, providing instruction on steps the individual can take to cure deficiencies in a Claim. The Claimant receiving notice of an incomplete Claim will be allowed thirty (30) days to submit materials to cure the deficiencies. If corrective information is not provided within thirty (30) days of a deficiency notice, the Claim will be denied. D. The Claims Administrator, upon reasonable request, shall provide to Class Counsel and Defendant’s Counsel summary information concerning the number of Claims made, number of Claims returned for incompleteness, and number of Claims pending in Claim Processing, number of Claims validated, and the total amount of reimbursement payments to be made on validated Claims. E. In any instance in which the Claims Administrator finally denies a Claim and the Claimant disputes the denial, the Claims Administrator shall forward such Claims to Class Counsel and Defendant’s counsel. The Parties through their respective counsel will engage in good faith efforts to resolve the dispute as to that Claim (each party to bear his, her or its own respective costs for such efforts). If counsel are unable to resolve the dispute, the Claimant may then appeal the denial of the Claim to the National Center for Dispute Settlement (“NCDS”), which is a third-party neutral, provided that any such appeal must be filed within sixty (60) days of final denial by the Settlement Administrator and any decision by the NCDS will be final and binding upon the Par...

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. B. Appeals of decisions of the administrator shall be through the grievance procedure. An Employee may submit his grievance through Union directly to Step 2 of the procedure. Such grievance must be submitted within twenty (20) calendar days of receipt of notification of the decision of the administrator. C. The parties agree that for the purposes of administering Injury Leave as it applies to members of this bargaining unit, Employees awaiting a final decision of the Claims Administrator shall be eligible to use all accumulated sick, vacation, or compensatory leave accruals available to them. Employees without such accruals may have their salary continued at the discretion of the Fire Chief or his/her designee until such time as a final decision from the Claims Administrator is rendered. The parties agree that the City may correct any inappropriate compensation provided under such a continuation (based on a decision involving Injury Leave denial) through means which may include either payroll or other leave correction.

Claims Administrator. An organization or group responsible for processing claims and associated services for a health plan.

Claims Administrator. 11.2.1 The Claims Administrator will oversee the Settlement Program and will work with the Claims Processor, the Special Masters, the SOC and HOC, and others to ensure that the express terms and intent of this Agreement are properly and fairly applied in the Settlement Program and that clear errors are avoided. The Claims Administrator shall be authorized to make final and binding determinations under this Agreement with the authority of an Arbitrator under the Federal Arbitration Act. 11.2.2 The SOC and HOC agree that the Claims Administrator is ▇▇▇. ▇▇▇▇▇ ▇. Welsh (▇▇▇.), and/or her agents, or upon her resignation or removal, any Person(s) to be appointed by the Parties.

Claims Administrator. The Claims Administrator is responsible for ensuring prompt and accurate provider claims processing. Sufficient staffing under this position must be in place to ensure the timely and accurate processing of original claims, resubmissions, and overall adjudication of claims. Develop and implement claims processing systems capable of paying claims in accordance with state and federal requirements; Develop processes for cost avoidance; Ensure minimization of claims recoupments; and Ensure claims processing timelines are met.

Claims Administrator. The Class shall retain a Claims Administrator, which shall be responsible for the claims administration process, distribution to the Class, withholding and paying applicable taxes, and other duties as provided herein. The fees and expenses of the Claims Administrator shall be paid exclusively out of the Settlement Fund. In no event shall KEMET be separately responsible or liable for any fees or expenses of the Claims Administrator.

Claims Administrator. “Claims Administrator” shall mean The Garden City Group, Inc., which shall provide services to the Parties to facilitate administrative matters and distribution of the Amount Payable for Each Valid Claim in accordance with the terms and conditions of this Agreement.

Claims Administrator. The Parties agree to cooperate as to all aspects of this Agreement to minimize the costs of the Claims Administrator. All payments to the Claims Administrator must be for reasonable and necessary services in accordance with detailed invoices provided to the Parties and approved by the Court or the Special Master as the Court may designate. Class Counsel shall be responsible for submitting such invoices to the Court and may include invoices for the Claims Administrator’s fees, expenses and costs incurred prior to Preliminary Approval.

Claims Administrator. 5.1. Pursuant to the Preliminary Approval Order and subject to Court approval, Bond- holder Plaintiffs’ Counsel shall engage a Claims Administrator. 5.2. The Claims Administrator shall, under the direction of the Court and/or Bondholder Plaintiffs’ Counsel, take all steps reasonably necessary to effectuate the notice plan approved by order(s) of the Court, assist in the development of the Distribution Plan, assist in the identification of Bondholder Class Members, administer and calculate the claims submitted by Bondholder Class Members, oversee distribution of the Net Settlement Fund to Authorized Claimants in accordance with the Distribution Plan, and perform such other tasks and duties as directed by the Court and/or Bondholder Plaintiffs’ Counsel to effectuate this Agreement (collectively, “Claims Administra- tion”).