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