Will “Claims Manager” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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”
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Prepare reports to be submitted to company's data processing department.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Confer with legal counsel on claims requiring litigation.
- 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.
- 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.
- Pay and process claims within designated authority level.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- 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.
- 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.
Related Technology & Tools
- Personal computers
- Scanners
- Personal digital assistants PDA
- Notebook computers
- Tablet computers
- Desktop computers
- StrataCare StrataWare eReview
- Microsoft PowerPoint
- Bramerhill ClaimsTech
- CCC TL2000 Solution
- Insurance claims fraud detection software
- CSC Automated Work Distributor AWD
- Medical procedure coding software
- Fair Isaac SmartAdvisor
- Microsoft Excel
- Healthcare common procedure coding system HCPCS
- Tropics Claims Reserve Management
- AutoClaims Direct DirectLink
- Hyland OnBase Enterprise Content Management
- Bill review software
- CCC Pathways Appraisal Quality Solution
- ISO NetMap for Claims
- ISO ClaimSearch
- Captiva InputAccel
- Datanex ClaimTrac
- Clear Technology Tranzax
- BCCORP W5 for Adjusters
- LexisNexis RiskWise
- Hummingbird Legal Bill Review
- Axonwave Fraud and Abuse Management System
- Microsoft Office
- Magnify Predictive Targeting System
- First Notice Systems ClaimCapture
- Fair Isaac Claims Advisor
- Computerized voice stress analyzer CVSA software
- Corporate Systems ClaimsPro
- Automatic Data Processing Autosource
- Bridium Claims 3
- Brightwork Alyce Claims Systems
- Document management system software
- CCC EZNet electronic communications network
- CCC GuidePost Decision Support
- CGI INSideOUT
- Medical condition coding software
- Automatic Data Processing Claims Manager & Dispatch
- Agency Management Systems AMS 360
- Claims processing administration and management software
- CCC Pathways Image Management Solution
- Castek Insure3 Claims
- CSC Fault Evaluator
- IBM Fraud and Abuse Management System
- Covansys ClaimConnect
- Microsoft Word
- InSystems Calligo Document Management System