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