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