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