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