The Job Description of a Technical Claims Specialist
Since getting insurance has become an integral part of life in the U.S., the verification of the validity of claims filed with insurance companies has become equally integral to the insurance process. Without checks and balances, so to speak, and a technical claims specialist to oversee it, people could defraud insurance companies through false claims. The job of a technical claims specialist varies from organization to organization and even from department to department within an insurance agency.
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Reviewing Claims
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The technical claims specialist reviews claims filed with the insurance agency and checks for discrepancies and inaccuracies that would point to fraud. If a claim doesn't have any illegalities, then the specialist endorses it and moves it to the next stage.
Advising Customers on Processing Claims
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One of the important roles of the technical claims specialist is to provide technical advice and recommendations to customers for smoother processing of claims. Specialists are the first point of contact with the customer and, therefore, play a major role in establishing and sustaining good rapport with the customer.
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Performing Quality Audits
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The technical claims specialist performs quality audits of the processes, systems and procedures that the insurance agency uses.
Handling Technical Problems
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The technical claims specialist provides solutions or work-arounds to technical bottlenecks for both the insurance agency and the customers who file claims with the agency.
Serving in Administrative Role
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The technical claims specialist verifies facts, manages settlements, authorizes loans, approves insurance investment plans and verifies and approves redemptions and transfers.
Serving in Legal Role
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Very often the technical claims specialist works closely with the legal department to prepare correspondence regarding the claims. The legal role would encompass an advisory role when the insurance company is sued or challenged on any claims it has refused.
Serving in Policy-making Role
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In some cases, the technical claims specialist lends expertise into the shaping of new policy or changing, modifying, enhancing or recalling various policies that the insurance company has circulated. This policy-making role is one of the more important roles because such advice could very well influence the profits the insurance agency makes.
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