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