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