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