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