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