Will “Case Manager” be Replaced By Robots? 🤔
Unknown Chance of Automation
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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”
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- 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.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- 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.
- Present cases and participate in their discussion at claim committee meetings.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Confer with legal counsel on claims requiring litigation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Report overpayments, underpayments, and other irregularities.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Prepare reports to be submitted to company's data processing department.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Pay and process claims within designated authority level.
Related Technology & Tools
- Desktop computers
- Tablet computers
- Personal digital assistants PDA
- Personal computers
- Scanners
- Notebook computers
- First Notice Systems ClaimCapture
- Covansys ClaimConnect
- Hummingbird Legal Bill Review
- CSC Automated Work Distributor AWD
- Computerized voice stress analyzer CVSA software
- Fair Isaac Claims Advisor
- Microsoft Office
- ISO NetMap for Claims
- BCCORP W5 for Adjusters
- Brightwork Alyce Claims Systems
- Clear Technology Tranzax
- Microsoft PowerPoint
- Bramerhill ClaimsTech
- CCC Pathways Image Management Solution
- Bridium Claims 3
- Magnify Predictive Targeting System
- Datanex ClaimTrac
- CCC EZNet electronic communications network
- Captiva InputAccel
- Document management system software
- Microsoft Word
- Claims processing administration and management software
- CSC Fault Evaluator
- Insurance claims fraud detection software
- LexisNexis RiskWise
- CCC Pathways Appraisal Quality Solution
- CCC TL2000 Solution
- ISO ClaimSearch
- Corporate Systems ClaimsPro
- CCC GuidePost Decision Support
- Bill review software
- StrataCare StrataWare eReview
- Automatic Data Processing Claims Manager & Dispatch
- Automatic Data Processing Autosource
- Microsoft Excel
- Tropics Claims Reserve Management
- Healthcare common procedure coding system HCPCS
- Castek Insure3 Claims
- Fair Isaac SmartAdvisor
- Hyland OnBase Enterprise Content Management
- IBM Fraud and Abuse Management System
- Agency Management Systems AMS 360
- Medical condition coding software
- Medical procedure coding software
- CGI INSideOUT
- AutoClaims Direct DirectLink
- Axonwave Fraud and Abuse Management System
- InSystems Calligo Document Management System