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