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