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