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