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