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