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