Will “Check Examiner” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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”
- 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.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Confer with legal counsel on claims requiring litigation.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Prepare reports to be submitted to company's data processing department.
- 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.
- Report overpayments, underpayments, and other irregularities.
- 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.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Present cases and participate in their discussion at claim committee meetings.
- Pay and process claims within designated authority level.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
Related Technology & Tools
- Notebook computers
- Personal computers
- Scanners
- Desktop computers
- Personal digital assistants PDA
- Tablet computers
- Clear Technology Tranzax
- Castek Insure3 Claims
- IBM Fraud and Abuse Management System
- InSystems Calligo Document Management System
- CSC Fault Evaluator
- Hyland OnBase Enterprise Content Management
- Document management system software
- CCC GuidePost Decision Support
- Bill review software
- Fair Isaac Claims Advisor
- Medical procedure coding software
- Hummingbird Legal Bill Review
- CCC Pathways Appraisal Quality Solution
- Corporate Systems ClaimsPro
- CSC Automated Work Distributor AWD
- CGI INSideOUT
- ISO NetMap for Claims
- Microsoft Excel
- Covansys ClaimConnect
- Magnify Predictive Targeting System
- Insurance claims fraud detection software
- Brightwork Alyce Claims Systems
- Axonwave Fraud and Abuse Management System
- ISO ClaimSearch
- StrataCare StrataWare eReview
- Automatic Data Processing Autosource
- CCC TL2000 Solution
- Healthcare common procedure coding system HCPCS
- Agency Management Systems AMS 360
- Microsoft PowerPoint
- BCCORP W5 for Adjusters
- Bridium Claims 3
- Microsoft Office
- Microsoft Word
- Fair Isaac SmartAdvisor
- Claims processing administration and management software
- Computerized voice stress analyzer CVSA software
- CCC Pathways Image Management Solution
- Tropics Claims Reserve Management
- First Notice Systems ClaimCapture
- LexisNexis RiskWise
- Captiva InputAccel
- Datanex ClaimTrac
- AutoClaims Direct DirectLink
- Medical condition coding software
- Bramerhill ClaimsTech
- Automatic Data Processing Claims Manager & Dispatch
- CCC EZNet electronic communications network