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