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