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