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