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