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