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