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