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