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