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