Will “Claims Manager” 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 Consultant
- Claims Auditor
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
- Case Manager
Tasks for “Claims Manager”
- Pay and process claims within designated authority level.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- 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.
- Report overpayments, underpayments, and other irregularities.
- Prepare reports to be submitted to company's data processing department.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- 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.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Confer with legal counsel on claims requiring litigation.
- 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.
- 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.
Related Technology & Tools
- Desktop computers
- Personal digital assistants PDA
- Tablet computers
- Scanners
- Notebook computers
- Personal computers
- Bridium Claims 3
- Axonwave Fraud and Abuse Management System
- Healthcare common procedure coding system HCPCS
- Tropics Claims Reserve Management
- LexisNexis RiskWise
- Fair Isaac Claims Advisor
- CCC Pathways Appraisal Quality Solution
- AutoClaims Direct DirectLink
- Clear Technology Tranzax
- Automatic Data Processing Claims Manager & Dispatch
- Magnify Predictive Targeting System
- CCC Pathways Image Management Solution
- Brightwork Alyce Claims Systems
- Datanex ClaimTrac
- ISO ClaimSearch
- CCC TL2000 Solution
- Agency Management Systems AMS 360
- Microsoft Office
- First Notice Systems ClaimCapture
- CSC Automated Work Distributor AWD
- Hyland OnBase Enterprise Content Management
- BCCORP W5 for Adjusters
- Medical procedure coding software
- CGI INSideOUT
- Castek Insure3 Claims
- Bill review software
- Covansys ClaimConnect
- Document management system software
- Microsoft PowerPoint
- Medical condition coding software
- Corporate Systems ClaimsPro
- Computerized voice stress analyzer CVSA software
- ISO NetMap for Claims
- Microsoft Excel
- InSystems Calligo Document Management System
- Microsoft Word
- Claims processing administration and management software
- CSC Fault Evaluator
- Fair Isaac SmartAdvisor
- Insurance claims fraud detection software
- Automatic Data Processing Autosource
- StrataCare StrataWare eReview
- Hummingbird Legal Bill Review
- Bramerhill ClaimsTech
- CCC GuidePost Decision Support
- Captiva InputAccel
- IBM Fraud and Abuse Management System
- CCC EZNet electronic communications network