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