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