Insurance company’s reimbursement director or executive administrator who supervises and oversees employees who process insurance claims for payment.
Insurance Encyclopedia
Claims Occurrence Basis Liability Coverage
A type of public liability insurance that responds only to claims for injury or damage that occur during the policy period of insurance though are brought (to the insurer) during the policy period or even months or even years later.
Claims occurrence basis liability coverage (Liability Insurance)
Under this type of coverage, claims caused by an event that occurred during the term of a liability policy must be paid, even if the claim is not submitted during the term of the policy.
Claims Payable Abroad
A provision that may be inserted in a policy to permit the collection of claims payments from some specified person overseas.
Claims processor
See: insurance billing specialist .
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US,MEDICAL: Employed representative of the insurance company who is responsible for handling insurance claims as they are received from patients and medical practices and who determines the dollar amount of a claim or debt. Also called adjuster, claims examiner, claims representative, claims administrator, or health insurance adjuster .
Claims representative
See: claims processor.
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Refer: “Adjuster.”
Claims Reserve
Claims provision, provision for outstanding claims/claims outstanding including Claims notified but not paid and claims that may have arisen but that have not yet been reported.
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Money designated to cover the claims that have occurred but have not yet been settled.
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UK: The provision made in the accounts of an insurer in respect of claims notified but not yet settled. See CHAIN LADDER METHOD.
Claims review
Audit by a peer review organization, insurance company, or other group of insurance claims submitted by a provider to validate payment or nonpayment, eligibility, or establish medical necessity of care and appropriateness of services provided.
Claims reviewer
Insurance company’s reimbursement employee who analyzes insurance claims similar to an auditor who checks procedure and diagnostic codes, prior authorizations, insurance contract violations, and so on.
Claims series clause
A clause in a liability or reinsurance contract designed to treat a series of loss occurrences unified by a common cause as a single loss. This means that any deductible or retention will be applied only to the aggregate of individual claims arising from the common cause and not to the claims individually. For example, individual claims originating in the same product design fault would be aggregated and might breach the deductible while each one individually might fall below it. The clause also has a bearing on the application of limits of indemnity. See HOURS CLAUSE; ORIGINATING CAUSE.