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