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