Will “Insurance Auditor” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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”
- 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.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- 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.
- Pay and process claims within designated authority level.
- 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.
- Present cases and participate in their discussion at claim committee meetings.
- 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.
- 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.
- Prepare reports to be submitted to company's data processing department.
- Confer with legal counsel on claims requiring litigation.
Related Technology & Tools
- Personal computers
- Notebook computers
- Tablet computers
- Scanners
- Desktop computers
- Personal digital assistants PDA
- InSystems Calligo Document Management System
- Medical condition coding software
- Medical procedure coding software
- Fair Isaac Claims Advisor
- Corporate Systems ClaimsPro
- Automatic Data Processing Autosource
- CCC TL2000 Solution
- Fair Isaac SmartAdvisor
- Bill review software
- Axonwave Fraud and Abuse Management System
- Microsoft Office
- Brightwork Alyce Claims Systems
- CCC GuidePost Decision Support
- BCCORP W5 for Adjusters
- Datanex ClaimTrac
- CSC Automated Work Distributor AWD
- Claims processing administration and management software
- Computerized voice stress analyzer CVSA software
- CGI INSideOUT
- Bridium Claims 3
- Automatic Data Processing Claims Manager & Dispatch
- CCC Pathways Image Management Solution
- Bramerhill ClaimsTech
- AutoClaims Direct DirectLink
- StrataCare StrataWare eReview
- Hummingbird Legal Bill Review
- Castek Insure3 Claims
- Magnify Predictive Targeting System
- CCC EZNet electronic communications network
- Tropics Claims Reserve Management
- Agency Management Systems AMS 360
- ISO ClaimSearch
- Microsoft Excel
- Document management system software
- IBM Fraud and Abuse Management System
- CCC Pathways Appraisal Quality Solution
- CSC Fault Evaluator
- First Notice Systems ClaimCapture
- ISO NetMap for Claims
- LexisNexis RiskWise
- Healthcare common procedure coding system HCPCS
- Insurance claims fraud detection software
- Covansys ClaimConnect
- Hyland OnBase Enterprise Content Management
- Microsoft PowerPoint
- Captiva InputAccel
- Microsoft Word
- Clear Technology Tranzax