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