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