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