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