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