Will “Claims Director” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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 Consultant
- Claims Auditor
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
- Case Manager
Tasks for “Claims Director”
- Prepare reports to be submitted to company's data processing department.
- Present cases and participate in their discussion at claim committee meetings.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- 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.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- 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.
- 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.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Confer with legal counsel on claims requiring litigation.
- 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.
- Report overpayments, underpayments, and other irregularities.
Related Technology & Tools
- Desktop computers
- Tablet computers
- Scanners
- Personal computers
- Personal digital assistants PDA
- Notebook computers
- ISO ClaimSearch
- Insurance claims fraud detection software
- Medical condition coding software
- CSC Automated Work Distributor AWD
- Medical procedure coding software
- Clear Technology Tranzax
- CGI INSideOUT
- Captiva InputAccel
- CSC Fault Evaluator
- Microsoft Excel
- Document management system software
- CCC Pathways Image Management Solution
- Agency Management Systems AMS 360
- Hummingbird Legal Bill Review
- AutoClaims Direct DirectLink
- CCC GuidePost Decision Support
- Hyland OnBase Enterprise Content Management
- Microsoft PowerPoint
- Fair Isaac Claims Advisor
- CCC Pathways Appraisal Quality Solution
- Healthcare common procedure coding system HCPCS
- LexisNexis RiskWise
- Microsoft Word
- Claims processing administration and management software
- InSystems Calligo Document Management System
- Microsoft Office
- Bramerhill ClaimsTech
- StrataCare StrataWare eReview
- Corporate Systems ClaimsPro
- Tropics Claims Reserve Management
- Automatic Data Processing Claims Manager & Dispatch
- ISO NetMap for Claims
- First Notice Systems ClaimCapture
- Computerized voice stress analyzer CVSA software
- CCC TL2000 Solution
- Covansys ClaimConnect
- Magnify Predictive Targeting System
- Castek Insure3 Claims
- Bridium Claims 3
- Brightwork Alyce Claims Systems
- IBM Fraud and Abuse Management System
- Datanex ClaimTrac
- BCCORP W5 for Adjusters
- Bill review software
- CCC EZNet electronic communications network
- Fair Isaac SmartAdvisor
- Automatic Data Processing Autosource
- Axonwave Fraud and Abuse Management System