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