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