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