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”
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Prepare reports to be submitted to company's data processing department.
- 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.
- Report overpayments, underpayments, and other irregularities.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- 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.
- 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.
- Present cases and participate in their discussion at claim committee meetings.
- 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.
- Pay and process claims within designated authority level.
Related Technology & Tools
- Desktop computers
- Personal digital assistants PDA
- Notebook computers
- Scanners
- Personal computers
- Tablet computers
- Microsoft Excel
- Microsoft Word
- BCCORP W5 for Adjusters
- Fair Isaac Claims Advisor
- Bridium Claims 3
- Automatic Data Processing Autosource
- InSystems Calligo Document Management System
- Medical procedure coding software
- IBM Fraud and Abuse Management System
- Brightwork Alyce Claims Systems
- Datanex ClaimTrac
- ISO NetMap for Claims
- Corporate Systems ClaimsPro
- Tropics Claims Reserve Management
- CCC Pathways Appraisal Quality Solution
- Bramerhill ClaimsTech
- Agency Management Systems AMS 360
- Axonwave Fraud and Abuse Management System
- Castek Insure3 Claims
- Hummingbird Legal Bill Review
- CCC TL2000 Solution
- CSC Fault Evaluator
- Clear Technology Tranzax
- CGI INSideOUT
- Fair Isaac SmartAdvisor
- Claims processing administration and management software
- AutoClaims Direct DirectLink
- Healthcare common procedure coding system HCPCS
- Magnify Predictive Targeting System
- Microsoft Office
- CCC Pathways Image Management Solution
- Bill review software
- CCC EZNet electronic communications network
- Captiva InputAccel
- Automatic Data Processing Claims Manager & Dispatch
- Microsoft PowerPoint
- Document management system software
- ISO ClaimSearch
- Hyland OnBase Enterprise Content Management
- LexisNexis RiskWise
- StrataCare StrataWare eReview
- First Notice Systems ClaimCapture
- CCC GuidePost Decision Support
- Computerized voice stress analyzer CVSA software
- Insurance claims fraud detection software
- Medical condition coding software
- Covansys ClaimConnect
- CSC Automated Work Distributor AWD