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