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