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