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