Will “Claims Supervisor” 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 Supervisor”
- Present cases and participate in their discussion at claim committee meetings.
- Pay and process claims within designated authority level.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Prepare reports to be submitted to company's data processing department.
- 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.
- 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.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Confer with legal counsel on claims requiring litigation.
- 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.
- 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.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Related Technology & Tools
- Scanners
- Personal digital assistants PDA
- Notebook computers
- Tablet computers
- Desktop computers
- Personal computers
- Corporate Systems ClaimsPro
- Tropics Claims Reserve Management
- Medical procedure coding software
- Hyland OnBase Enterprise Content Management
- Microsoft Excel
- Covansys ClaimConnect
- LexisNexis RiskWise
- IBM Fraud and Abuse Management System
- CSC Fault Evaluator
- CCC Pathways Appraisal Quality Solution
- Bridium Claims 3
- Hummingbird Legal Bill Review
- Clear Technology Tranzax
- Microsoft PowerPoint
- Fair Isaac SmartAdvisor
- Automatic Data Processing Claims Manager & Dispatch
- First Notice Systems ClaimCapture
- Document management system software
- BCCORP W5 for Adjusters
- CCC GuidePost Decision Support
- Automatic Data Processing Autosource
- Microsoft Word
- InSystems Calligo Document Management System
- Bramerhill ClaimsTech
- Agency Management Systems AMS 360
- ISO NetMap for Claims
- Axonwave Fraud and Abuse Management System
- ISO ClaimSearch
- Datanex ClaimTrac
- Microsoft Office
- Captiva InputAccel
- Insurance claims fraud detection software
- AutoClaims Direct DirectLink
- Bill review software
- Brightwork Alyce Claims Systems
- CCC TL2000 Solution
- Medical condition coding software
- Claims processing administration and management software
- CSC Automated Work Distributor AWD
- Castek Insure3 Claims
- StrataCare StrataWare eReview
- Fair Isaac Claims Advisor
- Healthcare common procedure coding system HCPCS
- Magnify Predictive Targeting System
- Computerized voice stress analyzer CVSA software
- CCC Pathways Image Management Solution
- CCC EZNet electronic communications network
- CGI INSideOUT