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Claims Manager:
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.
Occupation
Specific Tasks:
The tasks listed below are typical task
statements that are commonly required
for the occupation you selected.
Task
Description
| Adjust
reserves and provide reserve recommendations
to ensure reserving activities consistent
with corporate policies. |
| Communicate
with reinsurance brokers to obtain
information necessary for processing
claims. |
| Conduct
detailed bill reviews to implement
sound litigation management and
expense control. |
| Confer
with legal counsel on claims requiring
litigation. |
| Contact
and/or interview claimants, doctors,
medical specialists, or employers
to get additional information. |
| Enter
claim payments, reserves and new
claims on computer system, inputting
concise yet sufficient file documentation. |
| Examine
claims investigated by insurance
adjusters, further investigating
questionable claims to determine
whether to authorize payments. |
| 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. |
| Maintain
claim files, such as records of
settled claims and an inventory
of claims requiring detailed analysis. |
| Pay
and process claims within designated
authority level. |
| Prepare
reports to be submitted to company's
data processing department. |
| Present
cases and participate in their discussion
at claim committee meetings. |
| Report
overpayments, underpayments, and
other irregularities. |
| Resolve
complex, severe exposure claims,
using high service oriented file
handling. |
| Supervise
claims adjusters to ensure that
adjusters have followed proper methods. |
| 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. |
Detailed Work Activities.
| communicate
technical information |
| compile
information through interviews |
| confer
with prosecuting attorney |
| develop
management control systems |
| direct
and coordinate activities of workers
or staff |
| examine
documents for completeness, accuracy,
or conformance to standards |
| follow
contract, property, or insurance
laws |
| investigate
insurance claims |
| maintain
insurance records |
| maintain
records, reports, or files |
| make
presentations |
| note
discrepancies in financial records |
| obtain
information from individuals |
| prepare
reports |
| recommend
claim action |
| review
data on insurance applications or
policies |
| use
computers to enter, access or retrieve
data |
| use
interviewing procedures |
| use
knowledge of investigation techniques |
| verify
investigative information |
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