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