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