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