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”
- 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.
- Pay and process claims within designated authority level.
- 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.
- 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.
- 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.
- Report overpayments, underpayments, and other irregularities.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- 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.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Present cases and participate in their discussion at claim committee meetings.
Related Technology & Tools
- Tablet computers
- Personal digital assistants PDA
- Scanners
- Notebook computers
- Personal computers
- Desktop computers
- BCCORP W5 for Adjusters
- Hyland OnBase Enterprise Content Management
- Brightwork Alyce Claims Systems
- Document management system software
- First Notice Systems ClaimCapture
- Axonwave Fraud and Abuse Management System
- Bill review software
- Medical condition coding software
- Bridium Claims 3
- CSC Fault Evaluator
- ISO NetMap for Claims
- Fair Isaac Claims Advisor
- Automatic Data Processing Autosource
- Healthcare common procedure coding system HCPCS
- Hummingbird Legal Bill Review
- Corporate Systems ClaimsPro
- CGI INSideOUT
- Captiva InputAccel
- CSC Automated Work Distributor AWD
- Covansys ClaimConnect
- StrataCare StrataWare eReview
- CCC Pathways Appraisal Quality Solution
- Microsoft Office
- LexisNexis RiskWise
- Insurance claims fraud detection software
- InSystems Calligo Document Management System
- Tropics Claims Reserve Management
- Microsoft Excel
- Automatic Data Processing Claims Manager & Dispatch
- Agency Management Systems AMS 360
- CCC GuidePost Decision Support
- ISO ClaimSearch
- Computerized voice stress analyzer CVSA software
- Datanex ClaimTrac
- Bramerhill ClaimsTech
- Medical procedure coding software
- Clear Technology Tranzax
- Microsoft Word
- CCC TL2000 Solution
- AutoClaims Direct DirectLink
- Magnify Predictive Targeting System
- Claims processing administration and management software
- Fair Isaac SmartAdvisor
- Microsoft PowerPoint
- CCC EZNet electronic communications network
- Castek Insure3 Claims
- IBM Fraud and Abuse Management System
- CCC Pathways Image Management Solution