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