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