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