Claims Manager

Many third parties hire pharmacy benefit managers (PBMs) to provide prescription claims processing and other services. Examples of third parties that hire PBMs are insurance companies, employers, Medicare prescription drug plans, and state Medicaid programs. PBMs establish pharmacy networks as part of their claims management services, so many pharmacy third-party contracts are with PBMs. Examples of other ser-... 

Claims manager with Zurich insurance company makes decision with medical... 

Claims manager HMO Processing prior authorizations Pharmacy degree... 

Medicaid program Drug use review program and electronic claims management system for outpatient drug claims. Fed. Regist. 1992, 57, 49397-49412 (Nov. 2). 

Managing Workers Compensation A Guide to Injury Reduction and Effective Claim Management, Keith R. Wertz and James J. Bryant... 

Loss Control and Loss Prevention as titles did not convey clear images of purpose, and recognition of the function of those having such titles was poor. Loss Control was often believed to represent the security function of inventory control. On several occasions. Loss Prevention was assumed to be a part of claims management. 

Evidently the subject of claims management is an important one, worthy of specialized input which is beyond our present scope. For most purposes, project engineers concentrate their attention on rapidly and reasonably settling any problems which may otherwise escalate into a contractual dispute, and above all on eliminating the causes of such problems. 

Claims management is a legitimate employer response to compensation costs, even though it has nothing to do with improving OHS performance. There are also illegitimate responses, one of which is claims suppression. Consider the following case. 

One of these is more effective claims management. The national health and safety manager recounts how, when he first took on his job, he discovered more than a dozen people who had been off on workers compensation for more than three months and were clearly costing the company dearly. He went to visit each one at home and managed to get them all back to work on alternative duties. 

Both these responses—better claims management and preemployment screening—are rational ways to reduce workers compensation costs. Neither, it must be stressed, has anything to do with improving safety in the workplace. 

The LTI frequency rate is not a reliable indicator of the level of safety at Eastern, in part because of the extent to which it is influenced by claims management procedures which result in the conversion of LTIs into injuries without lost time. A further defect is that it fails to highlight major safety failures which need to be taken seriously, regardless of how many lost-time injuries may be occurring. For instance, fatalities are relatively rare, and most mines go for years without a death. However, when they occur they are usually indicative of serious safety deficiencies. Moreover, there are certain kinds of dangerous occurrences with the potential to lead to death or injury which must be reported to the inspectorate, regardless of whether injury has in fact occurred. Every such dangerous occurrence raises questions about standards of safety. 

The principal argument so far is that, if Eastern Colliery is any guide, compensation costs do relatively little to focus management s attention on safety (as opposed to claims management). What, if anything, does focus the mind of a coal mine manager on safety ... 

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