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