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