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