Will “Workers Compensation Claims Examiner” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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
- Worker's 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 “Workers Compensation Claims Examiner”
- Confer with legal counsel on claims requiring litigation.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Prepare reports to be submitted to company's data processing department.
- 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.
- Pay and process claims within designated authority level.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Report overpayments, underpayments, and other irregularities.
- Present cases and participate in their discussion at claim committee meetings.
- 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.
- 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.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
Related Technology & Tools
- Scanners
- Tablet computers
- Personal computers
- Notebook computers
- Desktop computers
- Personal digital assistants PDA
- Corporate Systems ClaimsPro
- Medical procedure coding software
- Castek Insure3 Claims
- First Notice Systems ClaimCapture
- Axonwave Fraud and Abuse Management System
- Covansys ClaimConnect
- Claims processing administration and management software
- CSC Fault Evaluator
- CCC Pathways Image Management Solution
- Datanex ClaimTrac
- CCC TL2000 Solution
- Medical condition coding software
- CCC Pathways Appraisal Quality Solution
- ISO ClaimSearch
- IBM Fraud and Abuse Management System
- Automatic Data Processing Autosource
- Clear Technology Tranzax
- ISO NetMap for Claims
- AutoClaims Direct DirectLink
- Captiva InputAccel
- CCC GuidePost Decision Support
- CGI INSideOUT
- Hummingbird Legal Bill Review
- Hyland OnBase Enterprise Content Management
- Fair Isaac Claims Advisor
- StrataCare StrataWare eReview
- CCC EZNet electronic communications network
- CSC Automated Work Distributor AWD
- Brightwork Alyce Claims Systems
- Bill review software
- Tropics Claims Reserve Management
- Bridium Claims 3
- Magnify Predictive Targeting System
- Microsoft PowerPoint
- Bramerhill ClaimsTech
- Microsoft Excel
- BCCORP W5 for Adjusters
- Document management system software
- Healthcare common procedure coding system HCPCS
- InSystems Calligo Document Management System
- Computerized voice stress analyzer CVSA software
- Microsoft Word
- Automatic Data Processing Claims Manager & Dispatch
- Microsoft Office
- Fair Isaac SmartAdvisor
- Insurance claims fraud detection software
- LexisNexis RiskWise
- Agency Management Systems AMS 360