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