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