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