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