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