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