Will “Claims Consultant” 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 Auditor
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
- Case Manager
Tasks for “Claims Consultant”
- Report overpayments, underpayments, and other irregularities.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- 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.
- Present cases and participate in their discussion at claim committee meetings.
- 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.
- 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.
- Prepare reports to be submitted to company's data processing department.
- 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.
- 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.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Pay and process claims within designated authority level.
Related Technology & Tools
- Tablet computers
- Desktop computers
- Personal computers
- Notebook computers
- Scanners
- Personal digital assistants PDA
- CCC Pathways Appraisal Quality Solution
- Insurance claims fraud detection software
- LexisNexis RiskWise
- Tropics Claims Reserve Management
- CCC GuidePost Decision Support
- Automatic Data Processing Autosource
- CSC Fault Evaluator
- CCC Pathways Image Management Solution
- Microsoft PowerPoint
- Automatic Data Processing Claims Manager & Dispatch
- Magnify Predictive Targeting System
- Bill review software
- Corporate Systems ClaimsPro
- Bridium Claims 3
- Agency Management Systems AMS 360
- IBM Fraud and Abuse Management System
- ISO ClaimSearch
- Hyland OnBase Enterprise Content Management
- ISO NetMap for Claims
- CSC Automated Work Distributor AWD
- Fair Isaac Claims Advisor
- AutoClaims Direct DirectLink
- Covansys ClaimConnect
- BCCORP W5 for Adjusters
- Medical procedure coding software
- Medical condition coding software
- CCC TL2000 Solution
- Microsoft Excel
- Hummingbird Legal Bill Review
- Bramerhill ClaimsTech
- Computerized voice stress analyzer CVSA software
- Fair Isaac SmartAdvisor
- Datanex ClaimTrac
- Document management system software
- Captiva InputAccel
- Castek Insure3 Claims
- First Notice Systems ClaimCapture
- InSystems Calligo Document Management System
- Clear Technology Tranzax
- Microsoft Office
- CGI INSideOUT
- Claims processing administration and management software
- Brightwork Alyce Claims Systems
- Healthcare common procedure coding system HCPCS
- StrataCare StrataWare eReview
- CCC EZNet electronic communications network
- Microsoft Word
- Axonwave Fraud and Abuse Management System