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