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