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.
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Claims Examiner has the meaning defined in Section 4.1(1);
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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.

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

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

  • 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 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.
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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 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 a claims examiner as defined under 39-71-116,
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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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Related to Claims Examiner

  • 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.

  • 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.

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

  • 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 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)).

  • Seller Related Parties means, individually and collectively, Seller and its officers, directors, shareholder, employees, attorneys, agents and representatives. Buyer, by its execution hereof, acknowledges that the Property is sold “as-is where-is” and that Seller has not made, does not make and specifically negates and disclaims any representations, warranties, promises, covenants, agreements or guaranties of any kind or character whatsoever, whether express or implied, oral or written, past, present or future, as to, concerning or with respect to (a) the value, nature, quality or condition of the Property, including, without limitation, the water, soil and geology; (b) the existence of any environmental contamination, hazards or conditions thereon (including, but not limited to, the presence of asbestos or asbestos-containing materials, lead based paint, underground storage tanks, pesticide residues, landfills, or the release of hazardous substances or the disposal or existence, in or on the Property, of any hazardous materials); (c) the income to be derived from the Property; (d) the suitability of the Property for any and all activities and uses which Buyer may conduct thereon;

  • 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.