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