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