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