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