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