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