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