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