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