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