Will “Claims Specialist” 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 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 Representative
- Liability Claims Manager
- Liability Claims Examiner
- Insurance Examiner
- Insurance Auditor
- Home Office Claims Examiner
- Executive Relations Specialist
- Claims Vice President
- Claims Specialist
- Claims Director
- Claims Consultant
- Claims Auditor
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
- Case Manager
Tasks for “Claims Specialist”
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Confer with legal counsel on claims requiring litigation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- 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.
- 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.
- Pay and process claims within designated authority level.
- Prepare reports to be submitted to company's data processing department.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- 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.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Present cases and participate in their discussion at claim committee meetings.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
Related Technology & Tools
- Notebook computers
- Personal digital assistants PDA
- Scanners
- Desktop computers
- Tablet computers
- Personal computers
- Medical procedure coding software
- Tropics Claims Reserve Management
- Microsoft Office
- Bridium Claims 3
- CSC Fault Evaluator
- BCCORP W5 for Adjusters
- CSC Automated Work Distributor AWD
- StrataCare StrataWare eReview
- CCC Pathways Appraisal Quality Solution
- Microsoft PowerPoint
- Corporate Systems ClaimsPro
- ISO NetMap for Claims
- Clear Technology Tranzax
- LexisNexis RiskWise
- CCC TL2000 Solution
- CCC GuidePost Decision Support
- IBM Fraud and Abuse Management System
- InSystems Calligo Document Management System
- Covansys ClaimConnect
- Fair Isaac Claims Advisor
- Bill review software
- AutoClaims Direct DirectLink
- CCC EZNet electronic communications network
- Castek Insure3 Claims
- Medical condition coding software
- ISO ClaimSearch
- Agency Management Systems AMS 360
- CGI INSideOUT
- Computerized voice stress analyzer CVSA software
- Insurance claims fraud detection software
- Captiva InputAccel
- Microsoft Word
- Fair Isaac SmartAdvisor
- Microsoft Excel
- Automatic Data Processing Claims Manager & Dispatch
- Magnify Predictive Targeting System
- Document management system software
- Bramerhill ClaimsTech
- Brightwork Alyce Claims Systems
- Claims processing administration and management software
- First Notice Systems ClaimCapture
- Healthcare common procedure coding system HCPCS
- Axonwave Fraud and Abuse Management System
- Hyland OnBase Enterprise Content Management
- Hummingbird Legal Bill Review
- Automatic Data Processing Autosource
- Datanex ClaimTrac
- CCC Pathways Image Management Solution