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