Will “Claims Director” 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 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.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Confer with legal counsel on claims requiring litigation.
- 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.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Present cases and participate in their discussion at claim committee meetings.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Pay and process claims within designated authority level.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Report overpayments, underpayments, and other irregularities.
- 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.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Resolve complex, severe exposure claims, using high service oriented file handling.
Related Technology & Tools
- Personal digital assistants PDA
- Notebook computers
- Scanners
- Desktop computers
- Personal computers
- Tablet computers
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- Agency Management Systems AMS 360
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- Clear Technology Tranzax
- Microsoft Excel
- Document management system software
- CCC TL2000 Solution
- BCCORP W5 for Adjusters
- Automatic Data Processing Claims Manager & Dispatch
- Bill review software
- Brightwork Alyce Claims Systems
- Bridium Claims 3
- Automatic Data Processing Autosource
- CCC GuidePost Decision Support
- Covansys ClaimConnect
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- Fair Isaac SmartAdvisor
- Captiva InputAccel
- Microsoft Office
- StrataCare StrataWare eReview
- CSC Fault Evaluator
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- Medical condition coding software
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- ISO ClaimSearch
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- Corporate Systems ClaimsPro
- ISO NetMap for Claims
- First Notice Systems ClaimCapture
- CSC Automated Work Distributor AWD
- Healthcare common procedure coding system HCPCS
- Hyland OnBase Enterprise Content Management
- IBM Fraud and Abuse Management System
- Datanex ClaimTrac
- Microsoft Word
- AutoClaims Direct DirectLink
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- Tropics Claims Reserve Management
- CGI INSideOUT
- LexisNexis RiskWise
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