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