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