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