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