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