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