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