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