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