Claims Adjudicator Job Description

Social Security Disability Claims Adjudicator

More than 2 million people applied for Social Security disability benefits. When a physical or mental impairment renders work impossible, disability benefits can provide income for those who paid Social Security tax on their earnings. The Social Security Administration field offices process claims for disability.

The disability claim adjudicator is in charge of drafting personalized correspondence to inform the claimr of their benefits. Authorization for professional services used to evaluate a claim is included in closing a case. Disability claim adjudicators may be called to evaluate cases.

Communication skills, both oral and written, are important in claims adjudication, as is the ability to use a variety of computer applications. Disability claims adjudicators have an ability to learn and understand medical terminology and conditions. They work well under pressure and can juggle cases.

Auto-Adjudication of Insurance Claims

The process of paying claims submitted or denying them after comparing claims to the benefit or coverage requirements is called claims adjudication. The process of adjudication involves receiving a claim from an insured person and then using software to process the claims and make a decision. The claim process is called auto-adjudication if it is done using software or a web-based subscription.

Automating claims can improve efficiency and reduce expenses. Many claims are submitted on paper and are not processed by humans. Many insurance companies use auto-adjudication to manage large number of claims that have to be processed on a regular basis.

Paper filing is still an option in most cases, although the information is entered into software that reviews the claims. Some software programs check for fraud and even check for errors. The claim will be paid if it meets the requirements.

If the claim fails the auto-adjudication process, it can be denied or sent to an insurance examiner to review it manually. The insurance company will usually send a letter to the filer after the claims adjudication process is over. The letter that is referred to as remittance advice has a statement about whether the claim was approved or denied.

If the company denied the claim, it usually has to explain why. The company often gives an explanation of benefits that includes details about how each service was settled. If the claims are approved, the insurance companies will send the payments to the providers.

Identifying Issues in an Unemployment Claims Decision

Issues that may affect eligibility are identified when an unemployment claim is filed. Some issues may be identified as a result of how the person left their job. The willingness or ability of the claimant to seek and perform full-time work or the claimant's availability may be the cause of other issues.

The unemployment adjudicator looks at claims on which issues have been identified to determine if the issue would make the person ineligible to receive unemployment benefits. The adjudicator gives the claimsman explanations about their rights and the procedures for appeal in cases where the decision is not in their favor. The decision regarding an unemployment claim is recorded in writing when an adjudicator makes a substative decision.

Each issue is considered by the unemployment law, codes and procedures, as well as the circumstances of the individual case. The basis for making the decision and the responsibility of the adjudicator to prepare a written statement that identifies it are the things that are responsible for the written statement. When errors are discovered, adjudicators may make appropriate recommendations for corrective action.