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