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