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