Will “Case Manager” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
Job Description
Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.
Job Details
- The SOC (Standard Occupational Classification) code is 13-1031.01
☝️ Information based on the reference occupation “Claims Examiners, Property and Casualty Insurance”.
Also Known As…
- Claims Examiners, Property and Casualty Insurance
- Home Office Claim Specialist
- Customer Care Specialist
- Corporate Claims Examiner
- Claims Supervisor
- Claims Specialist
- Claims Representative
- Claims Manager
- Claims Examiner
- Claims Analyst
- Claims Adjuster
- Workers Compensation Examiner
- Workers Compensation Claims Examiner
- Worker's Compensation Claims Examiner
- Reinsurance Claim Analyst
- Property Damage Claims Adjustor
- Litigation Examiner
- Liability Claims Representative
- Liability Claims Manager
- Liability Claims Examiner
- Insurance Examiner
- Insurance Auditor
- Home Office Claims Examiner
- Executive Relations Specialist
- Claims Vice President
- Claims Director
- Claims Consultant
- Claims Auditor
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
Tasks for “Case Manager”
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Pay and process claims within designated authority level.
- Present cases and participate in their discussion at claim committee meetings.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Prepare reports to be submitted to company's data processing department.
- Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Report overpayments, underpayments, and other irregularities.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Confer with legal counsel on claims requiring litigation.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
Related Technology & Tools
- Tablet computers
- Desktop computers
- Personal computers
- Personal digital assistants PDA
- Notebook computers
- Scanners
- ISO NetMap for Claims
- Hummingbird Legal Bill Review
- CSC Automated Work Distributor AWD
- LexisNexis RiskWise
- Medical condition coding software
- Agency Management Systems AMS 360
- Clear Technology Tranzax
- AutoClaims Direct DirectLink
- Automatic Data Processing Claims Manager & Dispatch
- StrataCare StrataWare eReview
- Microsoft Word
- Microsoft Excel
- CCC EZNet electronic communications network
- CCC TL2000 Solution
- BCCORP W5 for Adjusters
- CSC Fault Evaluator
- Fair Isaac SmartAdvisor
- Hyland OnBase Enterprise Content Management
- Bridium Claims 3
- Captiva InputAccel
- Tropics Claims Reserve Management
- Covansys ClaimConnect
- InSystems Calligo Document Management System
- CCC GuidePost Decision Support
- Medical procedure coding software
- Healthcare common procedure coding system HCPCS
- Brightwork Alyce Claims Systems
- First Notice Systems ClaimCapture
- Automatic Data Processing Autosource
- Insurance claims fraud detection software
- Corporate Systems ClaimsPro
- Computerized voice stress analyzer CVSA software
- Datanex ClaimTrac
- Microsoft PowerPoint
- CCC Pathways Image Management Solution
- CGI INSideOUT
- Microsoft Office
- Fair Isaac Claims Advisor
- ISO ClaimSearch
- Magnify Predictive Targeting System
- Bill review software
- CCC Pathways Appraisal Quality Solution
- Bramerhill ClaimsTech
- Castek Insure3 Claims
- IBM Fraud and Abuse Management System
- Document management system software
- Axonwave Fraud and Abuse Management System
- Claims processing administration and management software