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