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