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