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