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