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