Claims Examiner definition

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.
Sample 1Sample 2
Claims Examiner has the meaning defined in Section 4.1(1);
Sample 1Sample 2Sample 3
Claims Examiner means staff employed by Zenith to process claims.
Sample 1Sample 2Sample 3

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.

  • 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.

  • 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.

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

  • 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).

  • 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.

  • Within ten (10) Days of receiving the Detailed Claim, the non-claimant shall have the right to submit to the Claims Examiner a formal response to the Detailed Claim, confirming or rebutting the allegations and other details set forth in that Detailed Claim.

  • Some could include but is not limited to positions such as: Accountant, Claims Examiner, and Executive Assistant.

  • In the event the Parent determines, acting reasonably, that a True-Up Loss Amount and/or Verified True-Up Loss Amount is not materially different than the Loss Amount and/or Verified Loss Amount, as applicable, it may elect to not have the methodology set forth in Article 5.2 apply to such True-Up Loss Amount and will notify the Claims Examiner and relevant Enbridge Entity accordingly.


More Definitions of Claims Examiner

Claims Examiner means Simone Lelchuck and Jed Melnick of Melnick ADR, LLP.
Sample 1Sample 2
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 Bankruptcy 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 TFC or AMCAP filed by an Insider of either TFC or AMCAP, or an Affiliate of such Insider and (b) review and negotiate the terms of the Plan.
Sample 1
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.
Sample 1
Claims Examiner means non-clinical personnel employed by Zenith to process claims. They do not perform any aspect of Utilization Review, in compliance with
Sample 1
Claims Examiner means a claims examiner as defined under 39-71-116,
Sample 1
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:
Sample 1

Related to Claims Examiner

  • Medical examiner means that term as defined in 49 CFR 390.5.

  • Hearing examiner means the labor commissioner or the commissioner’s designee.

  • Examiner means the medical examiners as provided in KRS 61.665;

  • Claims Bar Date means the applicable bar date by which Proofs of Claim must be Filed, as established by: (a) the Bar Date Order; (b) a Final Order of the Bankruptcy Court; or (c) the Plan.

  • Claims Officer means the individual or individuals appointed by the Monitor pursuant to the Amended Claims Procedure Order;

  • 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 Administration means the processing of claims made under the Shared Policies, including the reporting of claims to the insurance carriers, management and defense of claims and providing for appropriate releases upon settlement of claims.

  • Unresolved Claims has the meaning set forth in Section 7.6(c).

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

  • Controller of Examinations means the Controller of Examinations of the University;

  • Asbestos claim means any claim, wherever or whenever made, for damages, losses, indemnification, contribution, or other relief arising out of, based on, or in any way related to asbestos, including:

  • Medical examination means the preliminary assessment of a person by an authorized health worker or by a person under the direct supervision of the competent authority, to determine the person’s health status and potential public health risk to others, and may include the scrutiny of health documents, and a physical examination when justified by the circumstances of the individual case;

  • Claims Made Policies has the meaning set forth in Section 5.01(b).

  • Civil action means all suits or claims of a civil nature in a state or federal court, whether cognizable as cases at law or in equity or admiralty. "Civil action" does not include any of the following:

  • Civil engineer means a professional engineer registered in the state of California to practice in the field of civil engineering.

  • Civil union means a civil union established pursuant to Act 91 of the 2000 Vermont Legislative Session, entitled “Act Relating to Civil Unions”.

  • Emergency medical condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition described in clause (i), (ii), or (iii) of section 1867(e)(1)(A) of the Social Security Act (42 U.S.C. 1395dd(e)(1)(A)). In that provision of the Social Security Act, clause (i) refers to placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; clause (ii) refers to serious impairment to bodily functions; and clause (iii) refers to serious dysfunction of any bodily organ or part.

  • Claims Bar Date Order means that certain order entered by the Bankruptcy Court establishing the Claims Bar Date.

  • Seller Related Parties means Seller and its Affiliates, and their respective fiduciaries, shareholders, equity holders, members, managers, partners, directors, divisions, officers, managers, executives, employees, independent contractors, freelancers, consultants and other Representatives, and the successors and assigns of each of them.

  • A grievance means a dispute or disagreement as to the interpretation or application of terms and conditions of employment contained in this Agreement.

  • 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.

  • Claims Objection Bar Date means the deadline for objecting to a Claim, which shall be on the date that is the later of (a) 180 days after the Effective Date and (b) such other period of limitation as may be specifically fixed by the Debtors or the Reorganized Debtors, as applicable, or by an order of the Bankruptcy Court for objecting to Claims.

  • Claims Agent means Kurtzman Carson Consultants LLC.

  • Shared Policies has the meaning set forth in Section 8.1(b).

  • Pending Litigation means a proceeding in a court of law whose activity is in progress but not yet completed.