Claims Management definition

Claims Management means the process of identifying, controlling and resolving demands by individuals or public entities to recover losses from any Member of the Association. Disposing of such demands for payment requires skills in insurance law, adjusting/investigation, loss control engineering and general business. Claims management is the function of supervising legal, adjusting, investigation and engineering services to resolve such demands.
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Claims Management means handling matters related to customers or third parties bringing a claim against a Party or claims by a Party against customers or third parties, including investigations, litigation support, and settlements.
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Claims Management means the entirety of the functions which are necessary for or incidental to the receipt, assessment, determination, payment, administration, review, finalisation and recording of a Claim.
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Examples of Claims Management in a sentence

  • Claims management risk may arise within the syndicate in the event of inaccurate or incomplete case reserves and claims settlements, poor service quality or excessive claims handling costs.

  • Claims management is the process by which Insurers fulfil their contractual obligation to policyholders.

  • Claims management and related health care data processing, including auditing payments, investigating and resolving payment disputes and responding to participant inquiries about payments.

  • Claims management shall continue until rectified, which may exceed the life of the contract period.

  • Claims management and related health care data processing, including auditing payments, investigating and resolving payment disputes, and responding to enrollees’ inquiries about payments.

  • Claims management companies – that is, any business which handles compensation claims for customers, including claims for personal injury or mis-sold financial products (such as payment protection insurance or PPI) – are authorised and regulated by the Ministry of Justice Claims Management Regulator (CMR) under the Compensation Act 2006, and must comply with the Conduct of Authorised Persons Rules 2013.

  • Claims management companies involved in non-compliant marketing or lead generation may be subject to CMR enforcement action, including having their licence revoked.

  • If such leave is not approved by Risk and Claims management, application may be made by the bargaining unit member to use sick leave, if available, and then application may be made for a medical leave of absence under University policy.

  • Claims management riskClaims management risk may arise within the Company in the event of inaccurate or incomplete case reserves and claims settlements, poor service quality or excessive claims handling costs.

  • Claims management and provisioning Once an incident has occurred, initial claim estimates are managed by claims officers with the requisite degree of experience and competence with the assistance, where appropriate, of a loss adjustor or other party with specialist knowledge of specific incidents.


More Definitions of Claims Management

Claims Management. To the extent different from Operational Accounting, Prudential Management and Underwriting Management, any System or Control and/or Mediation Activity in order to identify, account for, audit or otherwise analyse or verify, reserve against, settle, indemnify for or otherwise pay, or receive, any incurred or potential Flood Risk, including by way of any claim on any Inwards Reinsurance, Retrocession and/or ART Contract, including by reference to any event or circumstance which constitutes, gives, has given or may give rise to any Flood Risk in whole or in part, as further particularised in SOR section 5.4
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Claims Management means the effective coordination of all activities associated with the just and economic resolution of an injured Worker’s Claim and includes activities associated with determining liability, providing Benefits and processing the Claim.
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Claims Management means Third Party Claims Management, Inc., a Connecticut corporation and its successors and assigns.
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Claims Management shall have the meaning set forth in the Recitals.
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Claims Management means if you can’t prevent an injury, you can at least contain the financial damage. The employer has the onerous “burden of proof” meaning if you don’t have paper, you don’t have a leg to stand on. To avoid getting caught in a whirlwind of stories and injury causes that can change on a dime leaving you without support always address the following:1) Accident Investigation – Your way to guard the truth. Never forget the devil is in the details.2) Light Duty – Your only way to stay in control no matter how difficult it may be. Remember, the system makes the rules and has both the ability and the desire to enforce them whether you agree or not. In the end, don’t bepenny wise and pound foolish. Be smart and not predictably reactionary.3) Injured Worker Contact - Your way to learn of and report to your carrier unusual events, oddities of timing or observations that contradict the employee’s injury condition whether at work or if they are seen around the local area.
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Claims Management or "Claims Management Services" shall mean the process by which claims for payment are paid to Network Providers (but not non-Network Providers or non-Participating Providers) for Home Health Services provided to Network Members, including emergency and urgent services as defined by the Health Care Financing Administration, and records that are to be maintained of claims and payments for such services. Network shall provide Claims Management Services in accordance with Company standards, subject to Network's ability to cure pursuant to section 6.F hereof. Network represents, warrants and agrees that at all times its provision of Claims Management services meet or exceed (i) all Company standards, policies and procedures; (ii) all applicable state and federal statutes and regulations, including but not limited to, Medicare statues and regulations and all fiduciary obligations under ERISA; and (iii) the standards of any applicable accrediting organization, including, but not limited to, NCQA. In the event that Company or an accrediting organization's standards or any state or federal statutory or regulatory provisions are materially changed or revised, Network agrees, without limiting the Parties' rights and obligations pursuant to section 6.G hereof, to comply with or implement, as applicable, and to the reasonable good faith satisfaction of Company, any such change or revision within the earlier of sixty (60) calendar days of receiving notice of such change or within such time frame as may be required by the accrediting organization or applicable law or regulation. Company agrees to promptly notify Network of any and all such changes, whether through written communication or through the Operating Committee.
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Related to Claims Management

  • Supply Chain Management All aspects of supply chain management, from the initial sourcing phase through customer delivery (e.g., procurement, sourcing management, inventory management, catalog management, ordering/purchasing, invoice tracking, storefront/shopping cart, warehouse management, returns management, logistics/transportation).

  • Case management means a care management plan developed for a Member whose diagnosis requires timely coordination. All benefits, including travel and lodging, are limited to Covered Services that are Medically Necessary and set forth in the EOC. KFHPWA may review a Member's medical records for the purpose of verifying delivery and coverage of services and items. Based on a prospective, concurrent or retrospective review, KFHPWA may deny coverage if, in its determination, such services are not Medically Necessary. Such determination shall be based on established clinical criteria and may require Preauthorization.

  • Procurement Management means the Director of Lee County’s Procurement Management Department or designee.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Records management means the systematic control of all records from creation or receipt through processing, distribution, maintenance and retrieval, to their ultimate disposition.

  • Project Management The individuals appointed by each Party cf. clause 4.1 in the Agreement.

  • Claims Administration means the processing of claims made under the Shared Policies, including, without limitation, the reporting of claims to the insurance carriers and the management of the defense of claims.

  • PJM Management means the officers, executives, supervisors and employee managers of PJM. PJM Manuals:

  • Floodplain Management means the operation of an overall program of corrective and preventive measures for reducing flood damage, including but not limited to emergency preparedness plans, flood control works and floodplain management regulations.

  • Show Management means Questex Expositions, Questex LLC, its co-sponsors and their respective agents, employees and affiliates; (d) “Hall Manage- ment” means the owner or manager of the facility in which the Show is conducted, and its employees and agents; and (e) “Hall” means the facility in which the Show is conducted.

  • Medical assessment means an assessment of a patient’s medical condition secured by our Assistance Company working in conjunction with the Medical Evacuation Provider’s medical director and in collaboration with the attending physician. The Assistance Company in collaboration with the Medical Evacuation Provider, will utilize the assessment to determine at its sole discretion whether a Plan Holder is fit to fly; the most appropriate means to provide medical evacuation; the medical personnel who will be accompanying the patient on the transport; and to confirm the medical facility closest to one’s home can meet their medical needs. If the patient’s medical facility of choice is unable to provide the high level of medical care required by the patient, arrangements will be made to transport the patient to the appropriate medical facility closest to their home, or closest to patient's preferred medical facility in the US when possible.

  • Emergency management means lessening the effects of, preparations for, operations during, and recovery from natural, technological or human-caused disasters. These actions are broad in scope and include, but are not limited to: disaster plans, mitigation, preparedness, response, warning, emergency operations, training, exercising, research, rehabilitation, and recovery activities.

  • Project Management Plan means the management plan that (i) sets out a high level workplan to describe the manner in which the Design-Builder will manage the Project, including to address related matters such as traffic management and communications, and (ii) is prepared by or for the Design-Builder and submitted to the Owner;

  • City’s Manager means a manager who at the relevant time carries such designation from the City under, or in accordance with, ARTICLE 5;

  • Project Management Report means each report prepared in accordance with Section 4.02 of this Agreement;

  • Stormwater management means the programs to maintain quality and quantity of stormwater runoff to pre-development levels.

  • Mines Manager means the Mining Engineer so designated for Jhamarkotra Rock Phosphate Mines of Rajasthan State Mines and Minerals Limited.

  • Construction management at-risk means a project delivery method in which the District awards separate contracts, one for architectural and engineering services to design an infrastructure facility and the second to a construction manager at-risk for both construction of the infrastructure facility according to the design and construction management services.

  • disaster management means a continuous and integrated process of planning, organising, coordinating and implementing measures which are necessary or expedient for—

  • Storm water management plan means a comprehensive plan designed to reduce the discharge of pollutants from storm water after the site has under gone final stabilization following completion of the construction activity.

  • Preschooler means a child age two through four years old.

  • Change Management means the add-on module to the Programs that enables engineers to define network changes through one or more configuration templates. Those network changes can be applied to multiple devices and executed/rolled back automatically. The Change Management module enables engineers to verify the impact of the changes across the network to help ensure a safer change process.

  • Management means an activity inclusive of control and performed on a daily basis, by any person who is a principal executive officer of the company, by whatever name that person may be designated, and whether or not that person is a director.

  • Intermittent Resource means a Generation Capacity Resource with output that can vary as a function of its energy source, such as wind, solar, run of river hydroelectric power and other renewable resources. Internal Market Buyer:

  • Pest Management Plan and “PMP” means the Recipient’s plan dated March 9, 2010, which: (i) addresses the concerns relating to the Project risks associated with potential increases in the use of pesticides for agricultural production, intensification and diversification and controlling disease vector populations arising from irrigation schemes; (ii) sets forth mitigation and monitoring measures to be taken during Project implementation and operation to eliminate adverse environmental and social impacts, offset them, or reduce them to acceptable levels; (iii) recommends institutional measures to strengthen national capacities to implement the mitigation and monitoring measures; and (iv) as part of the implementation arrangements, identifies national agencies and other partners that could play a vital role in the success of the Project.

  • Stormwater management plan means the set of drawings and other documents that comprise all the information and specifications for the programs, drainage systems, structures, BMPs, concepts and techniques intended to maintain or restore quality and quantity of stormwater runoff to pre-development levels.