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Law Offices of Scott Glovsky

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OUR OFFICES:
  • Claremont
    • 343 Harvard Avenue
      Claremont, CA 91711Get Directions
    • Call: (909) 296-7700
  • Pasadena
    • 299 N. Euclid Ave.
      Second Floor
      Pasadena, CA 91101
      Get Directions
    • Call: (626) 243-5598

(626) 243-5598

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  • Home
  • About
    • About Our Firm
    • About Scott Glovsky
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
        • Health Insurance Denials
          • Insurance Bad Faith
          • Health Insurance Claim Denials
          • Medical Necessity Denials
          • Experimental/Investigational Denials
          • Out-of-Network Denials
          • Insurance Policy Rescission
          • Health Insurance Denials Public Employees
          • Medicare Advantage Health Insurance Denial
          • We Fight All Health Insurance Companies, Including:
            • Aetna Denial
            • Anthem Blue Cross Denial
            • Blue Shield of California Denial
            • Cigna Denial
            • Health Net Denial
            • Kaiser Permanente Denial
            • OSCAR Health Plan Denial
            • Magellan Healthcare Denial
            • Molina Healthcare Denial
            • Regal Medical Group Denial
            • UnitedHealthcare Denial
        • Medications
          • Prescription Denial
          • Gene Therapy
          • Cancer Treatment
            • Proton Radiation Therapy
          • New Cancer Drugs
          • Expensive Drugs
          • Biologic Drugs
          • Cosentyx
          • Dupixent
          • Enbrel
          • Entyvio
          • Euflexxa
          • Harvoni
          • Humira
          • Intravenous Immunoglobulin (IVIG)
          • Ketamine
          • Leqembi™
          • Monovisc
          • Mounjaro
          • Orthovisc
          • Ozempic
          • POLIVY
          • Radicava
          • Remicade
          • Saxenda
          • Synvisc
          • Spinraza
          • SpaceOAR Hydrogel
          • Stelara
          • Wegovy
          • Xeljanz
          • Xifaxan
          • Zolgensma
        • Injuries & Surgeries
          • Spinal Cord Injury
          • Brain Injury
          • Surgery
          • Back Surgery
          • Ablation Surgery
          • Prosthetic Limb
          • Respite Care
          • Pain Treatment
          • Partial Hospitalization
          • Magnetic Resonance Imaging (MRI)
          • Radiofrequency Ablation (RFA)
        • Health Conditions
          • ALS
          • Alzheimer’s Disease and Dementia
          • Autism
          • Autoimmune Disorders
            • Ankylosing Spondylitis
            • Crohn’s Disease
            • Fibromyalgia
            • Lupus
            • Multiple Sclerosis
          • Blood Disorder
          • Cancer
            • Breast Cancer
            • Prostate Cancer
          • Cerebral Palsy
          • COVID-19
          • Counseling
          • Diabetes
          • Eating Disorder
          • Gastrointestinal Disorders
          • Genetic Testing
          • Genomic Testing
          • Heart Condition
          • Hydrocephalus
          • Intensive Outpatient Program
          • Mental Health
            • Anxiety
            • Bipolar Disorder
            • Depression
            • PTSD
          • Migraine
          • Musculoskeletal Treatment
          • Obesity
          • Osteoarthritis
          • Parkinson's Disease
          • Postural Orthostatic Tachycardia Syndrome
          • Residential Treatment Center (RTC)
          • Retinal Disorders
          • Rheumatoid Arthritis
          • Skin Treatment
          • Spinal Muscular Atrophy
          • Substance Use Disorders & Addiction
          • Ulcerative Colitis
        • Personal Injury
          • Accidents
            • Bicycle Accidents
            • Car Accidents
            • Motorcycle Accidents
            • Truck Accidents
          • Traumatic Brain Injury
          • Catastrophic Injury
          • Burn Injury
          • Wrongful Death
          • Premise Liability
          • Slip & Fall
          • Product Liability
          • Nursing Home Abuse
          • Elder Abuse
        • Sexual Abuse
          • Types of Sexual Abuse
          • Child Sexual Abuse
          • Campus Abuse
          • Special Needs Abuse
          • Abuse at School
          • Abuse at Camp
          • Abuse by a Clergy Member
          • Abuse by Athletic Coaches
        • Business Issues
          • Employment & Business Issues
          • Broker & Agent Negligence
          • Business Contingency Litigation
          • Unfair Business Practices
          • Workplace Harassment
          • Wrongful Termination
          • Whistleblower
            • Qui-Tam
  • Results
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  • In The Media
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    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact
Contact Us
Call Us
  • Home
  • About
    • About Our Firm
    • About Scott Glovsky
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
        • Health Insurance Denials
          • Insurance Bad Faith
          • Health Insurance Claim Denials
          • Medical Necessity Denials
          • Experimental/Investigational Denials
          • Out-of-Network Denials
          • Insurance Policy Rescission
          • Health Insurance Denials Public Employees
          • Medicare Advantage Health Insurance Denial
          • We Fight All Health Insurance Companies, Including:
            • Aetna Denial
            • Anthem Blue Cross Denial
            • Blue Shield of California Denial
            • Cigna Denial
            • Health Net Denial
            • Kaiser Permanente Denial
            • OSCAR Health Plan Denial
            • Magellan Healthcare Denial
            • Molina Healthcare Denial
            • Regal Medical Group Denial
            • UnitedHealthcare Denial
        • Medications
          • Prescription Denial
          • Gene Therapy
          • Cancer Treatment
            • Proton Radiation Therapy
          • New Cancer Drugs
          • Expensive Drugs
          • Biologic Drugs
          • Cosentyx
          • Dupixent
          • Enbrel
          • Entyvio
          • Euflexxa
          • Harvoni
          • Humira
          • Intravenous Immunoglobulin (IVIG)
          • Ketamine
          • Leqembi™
          • Monovisc
          • Mounjaro
          • Orthovisc
          • Ozempic
          • POLIVY
          • Radicava
          • Remicade
          • Saxenda
          • Synvisc
          • Spinraza
          • SpaceOAR Hydrogel
          • Stelara
          • Wegovy
          • Xeljanz
          • Xifaxan
          • Zolgensma
        • Injuries & Surgeries
          • Spinal Cord Injury
          • Brain Injury
          • Surgery
          • Back Surgery
          • Ablation Surgery
          • Prosthetic Limb
          • Respite Care
          • Pain Treatment
          • Partial Hospitalization
          • Magnetic Resonance Imaging (MRI)
          • Radiofrequency Ablation (RFA)
        • Health Conditions
          • ALS
          • Alzheimer’s Disease and Dementia
          • Autism
          • Autoimmune Disorders
            • Ankylosing Spondylitis
            • Crohn’s Disease
            • Fibromyalgia
            • Lupus
            • Multiple Sclerosis
          • Blood Disorder
          • Cancer
            • Breast Cancer
            • Prostate Cancer
          • Cerebral Palsy
          • COVID-19
          • Counseling
          • Diabetes
          • Eating Disorder
          • Gastrointestinal Disorders
          • Genetic Testing
          • Genomic Testing
          • Heart Condition
          • Hydrocephalus
          • Intensive Outpatient Program
          • Mental Health
            • Anxiety
            • Bipolar Disorder
            • Depression
            • PTSD
          • Migraine
          • Musculoskeletal Treatment
          • Obesity
          • Osteoarthritis
          • Parkinson's Disease
          • Postural Orthostatic Tachycardia Syndrome
          • Residential Treatment Center (RTC)
          • Retinal Disorders
          • Rheumatoid Arthritis
          • Skin Treatment
          • Spinal Muscular Atrophy
          • Substance Use Disorders & Addiction
          • Ulcerative Colitis
        • Personal Injury
          • Accidents
            • Bicycle Accidents
            • Car Accidents
            • Motorcycle Accidents
            • Truck Accidents
          • Traumatic Brain Injury
          • Catastrophic Injury
          • Burn Injury
          • Wrongful Death
          • Premise Liability
          • Slip & Fall
          • Product Liability
          • Nursing Home Abuse
          • Elder Abuse
        • Sexual Abuse
          • Types of Sexual Abuse
          • Child Sexual Abuse
          • Campus Abuse
          • Special Needs Abuse
          • Abuse at School
          • Abuse at Camp
          • Abuse by a Clergy Member
          • Abuse by Athletic Coaches
        • Business Issues
          • Employment & Business Issues
          • Broker & Agent Negligence
          • Business Contingency Litigation
          • Unfair Business Practices
          • Workplace Harassment
          • Wrongful Termination
          • Whistleblower
            • Qui-Tam
  • Results
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact

What is the Role of Los Angeles Insurance Claim Specialists?

Home » Frequently Asked Questions » What is the Role of Los Angeles Insurance Claim Specialists?

Although it may feel like your health insurance claim just falls into a black hole or gets lost in a computer system once you send it to your insurance company, there are sometimes real people who review your claim. Usually, the person responsible for this task is an insurance claim specialist, sometimes also known as a claims examiner.

Unfortunately, while you might hope that the role of Los Angeles insurance claim specialists would be to assist you in getting your claim accepted, this is often not the case. Claims examiners are employed by insurance companies and often side against policyholders in the course of performing their job to their employer’s standards. If you feel that a claims specialist unfairly or illegally determined a denial for your claim, an experienced attorney may be able to help you.

Page Contents:

  • What Does an Insurance Claim Specialist Do?
  • Other Duties of an Insurance Claims Specialist
  • The Question of Relevant Qualifications
  • Get Assistance with Handling Los Angeles Insurance Claim Examiners

What Does an Insurance Claim Specialist Do?

The role of insurance claim specialists in Los Angeles is to review the claims of policyholders with the goal of determining whether it is covered under the claimant’s specific policy. They also evaluate how much the insurance company must legally pay on the claim and ensure that the proper claim filing procedure has been followed per company policy.

For complicated or unusual claims, an insurance claims specialist may also assist insurance adjustors. If claims need further review after the specialist has accepted or denied them, or when a decision has not yet been determined, they can be forwarded to a claim investigator for additional review.

Other Duties of an Insurance Claims Specialist

In addition to the above-mentioned duties, Los Angeles insurance claim specialists are also responsible for:

  • Examining complicated or unusual claims to determine coverage
  • Researching the cost of health treatments
  • Authorizing claim payments
  • Setting reserves on payment
  • Ensuring timely disbursement of funds to clients
  • Coordinating or conducting investigations on insurance claims
  • Recognizing claims with possible recovery from third parties
  • Consulting with attorneys, doctors, and agents regarding the status of complex claims

In the course of reviewing claims, a specialist may consult with claimants, medical professionals, and hospital or other records.

The Question of Relevant Qualifications

Claims specialists are required to follow the California Health and Safety Code when accepting or denying claims. However, according to the United States Bureau of Labor Statistics, educational, training, and licensing/certification for these specialists vary by state and by the individual employer.

As such, one inherent problem with claims specialists is that they sometimes do not have any type of medical education or experience. This can lead to claims being denied that should have been accepted. In these situations, getting help from an insurance attorney and pursuing civil action may be worthwhile.

Get Assistance with Handling Los Angeles Insurance Claim Examiners

The role of Los Angeles insurance claim specialists should be to facilitate the efficient and accurate review of insurance claims. If you believe such a specialist is potentially affecting the review, processing, or acceptance of your health insurance claim, an attorney who specializes in insurance coverage may be able to help.

Experienced legal counsel can go to bat for you in an effort to get payment for your claims. Just as the insurance claims specialist works for the insurance company and has their best interest in mind, your lawyer can work for you and your best interests. Call today to start exploring the possibilities in your case.

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343 Harvard Avenue
Claremont, CA 91711
(626) 243-5598
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Copyright © 2023 Law Offices of Scott Glovsky
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The Law Offices of Scott Glovsky is a Professional Corporation. Information on this website is not intended as and is not legal advice. The information does not establish an attorney-client relationship. Case results are not a prediction or guarantee of potential case outcomes. This website is an attorney advertisement.

  • Home
  • About
    ▼
    • About Our Firm
    • About Scott Glovsky
    • How Our Firm Has Changed Lives
    • How We Operate
  • Practice Areas
    ▼
    • Health Insurance Denials
      ▼
      • Insurance Bad Faith
      • Health Insurance Claim Denials
      • Medical Necessity Denials
      • Experimental/Investigational Denials
      • Out-of-Network Denials
      • Insurance Policy Rescission
      • Health Insurance Denials Public Employees
      • Medicare Advantage Health Insurance Denial
      • We Fight All Health Insurance Companies, Including:
        ▼
        • Aetna Denial
        • Anthem Blue Cross Denial
        • Blue Shield of California Denial
        • Cigna Denial
        • Health Net Denial
        • Kaiser Permanente Denial
        • OSCAR Health Plan Denial
        • Magellan Healthcare Denial
        • Molina Healthcare Denial
        • Regal Medical Group Denial
        • UnitedHealthcare Denial
    • Medications
      ▼
      • Prescription Denial
      • Gene Therapy
      • Cancer Treatment
        ▼
        • Proton Radiation Therapy
      • New Cancer Drugs
      • Expensive Drugs
      • Biologic Drugs
      • Cosentyx
      • Dupixent
      • Enbrel
      • Entyvio
      • Euflexxa
      • Harvoni
      • Humira
      • Intravenous Immunoglobulin (IVIG)
      • Ketamine
      • Leqembi™
      • Monovisc
      • Mounjaro
      • Orthovisc
      • Ozempic
      • POLIVY
      • Radicava
      • Remicade
      • Saxenda
      • Synvisc
      • Spinraza
      • SpaceOAR Hydrogel
      • Stelara
      • Wegovy
      • Xeljanz
      • Xifaxan
      • Zolgensma
    • Injuries & Surgeries
      ▼
      • Spinal Cord Injury
      • Brain Injury
      • Surgery
      • Back Surgery
      • Ablation Surgery
      • Prosthetic Limb
      • Respite Care
      • Pain Treatment
      • Partial Hospitalization
      • Magnetic Resonance Imaging (MRI)
      • Radiofrequency Ablation (RFA)
    • Health Conditions
      ▼
      • ALS
      • Alzheimer’s Disease and Dementia
      • Autism
      • Autoimmune Disorders
        ▼
        • Ankylosing Spondylitis
        • Crohn’s Disease
        • Fibromyalgia
        • Lupus
        • Multiple Sclerosis
      • Blood Disorder
      • Cancer
        ▼
        • Breast Cancer
        • Prostate Cancer
      • Cerebral Palsy
      • COVID-19
      • Counseling
      • Diabetes
      • Eating Disorder
      • Gastrointestinal Disorders
      • Genetic Testing
      • Genomic Testing
      • Heart Condition
      • Hydrocephalus
      • Intensive Outpatient Program
      • Mental Health
        ▼
        • Anxiety
        • Bipolar Disorder
        • Depression
        • PTSD
      • Migraine
      • Musculoskeletal Treatment
      • Obesity
      • Osteoarthritis
      • Parkinson’s Disease
      • Postural Orthostatic Tachycardia Syndrome
      • Residential Treatment Center (RTC)
      • Retinal Disorders
      • Rheumatoid Arthritis
      • Skin Treatment
      • Spinal Muscular Atrophy
      • Substance Use Disorders & Addiction
      • Ulcerative Colitis
    • Personal Injury
      ▼
      • Accidents
        ▼
        • Bicycle Accidents
        • Car Accidents
        • Motorcycle Accidents
        • Truck Accidents
      • Traumatic Brain Injury
      • Catastrophic Injury
      • Burn Injury
      • Wrongful Death
      • Premise Liability
      • Slip & Fall
      • Product Liability
      • Nursing Home Abuse
      • Elder Abuse
    • Sexual Abuse
      ▼
      • Types of Sexual Abuse
      • Child Sexual Abuse
      • Campus Abuse
      • Special Needs Abuse
      • Abuse at School
      • Abuse at Camp
      • Abuse by a Clergy Member
      • Abuse by Athletic Coaches
    • Business Issues
      ▼
      • Employment & Business Issues
      • Broker & Agent Negligence
      • Business Contingency Litigation
      • Unfair Business Practices
      • Workplace Harassment
      • Wrongful Termination
      • Whistleblower
        ▼
        • Qui-Tam
  • Results
    ▼
    • Testimonials
    • Case Results
  • In The Media
  • Resources
    ▼
    • Frequently Asked Questions
    • Trial Lawyer Talk Podcast
    • Fight Health Insurance Denials Book
    • Download Our eBook
    • Helpful Resources
    • Blog
    • Guides
    • Sign Up for Our Mailing List
    • Power of Resilience Scholarship
  • Contact