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