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