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