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