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