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