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