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