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