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