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