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