Will “Claim Examiner” be Replaced By Robots? 🤔
Unknown Chance of Automation
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Job Description
Investigate, analyze, and determine the extent of insurance company's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.
Job Details
- The SOC (Standard Occupational Classification) code is 13-1031.02
☝️ Information based on the reference occupation “Insurance Adjusters, Examiners, and Investigators”.
Also Known As…
- Insurance Adjusters, Examiners, and Investigators
- Litigation Claim Representative
- Independent Insurance Adjuster
- General Adjuster
- Field Liability Generalist
- Claims Specialist
- Claims Representative
- Claims Examiner
- Claims Analyst
- Claims Adjuster
- Claim Representative
- Workers Compensation Claims Adjuster
- Telephone Claims Representative
- Salvage Determiner
- Residential Insurance Inspector
- Property Claims Adjuster
- Property Adjuster
- Multi-line Claims Adjuster
- Medical Claims Specialist
- Medical Claims Examiner
- Medical Claims Analyst
- Material Damage Adjuster
- Job Estimator
- Investigator
- Insurance Inspector
- Insurance Claims Adjuster
- Insurance Appraiser
- Insurance Adjuster
- Inspector
- Health Claims Examiner
- Fire Adjuster
- Field Adjuster
- Examiner
- Estimator
- Disability Specialist
- Disability Examiner
- Compensation Adjuster
- Clerical Adjuster
- Claims Service Adjustor
- Claims Manager
- Claims Assistant
- Claims Adjustor
- Claim Specialist
- Claim Processor
- Claim Investigator
- Claim Inspector
- Claim Approver
- Claim Agent
- Claim Adjuster
- Catastrophe Claims Supervisor
- Building Appraiser
- Bodily Injury Adjuster
- Benefit Authorizer
- Auto Claims Adjuster
- Arson Investigator
- Appraiser
- Adjustment Clerk
- Adjuster
- Accident Investigator
Tasks for “Claim Examiner”
- Examine claims forms and other records to determine insurance coverage.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Obtain credit information from banks and other credit services.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Analyze information gathered by investigation and report findings and recommendations.
- Investigate and assess damage to property and create or review property damage estimates.
- Collect evidence to support contested claims in court.
- Prepare report of findings of investigation.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
Related Technology & Tools
- Measure markers
- Total stations
- Event data recorders
- Field computers
- Desktop computers
- Data collectors
- Mobile wireless handheld communication devices
- Handheld computers
- Personal digital assistants PDA
- ISO NetMap for Claims
- InSystems Calligo Document Management System
- Hummingbird Legal Bill Review
- Insurance claims fraud detection software
- IBM Fraud and Abuse Management System
- QwikQuote software
- CCC EZNet electronic communications network
- LexisNexis RiskWise
- Computerized voice stress analyzer CVSA software
- Automatic Data Processing Autosource
- CGI INSideOUT
- Simsol for Adjusters
- 4n6xprt Systems StiffCalcs
- CGI-AMS BureauLink Enterprise
- Covansys ClaimConnect
- Hyland OnBase Enterprise Content Management
- Corporate Systems ClaimsPro
- Claims processing administration and management software
- Visual Statement Investigator Suite
- ISO ClaimSearch
- Fair Isaac SmartAdvisor
- CSC Colossus
- Injury Sciences EDR InSight
- CCC Pathways Image Management Solution
- Autoclaims Direct DirectLink
- Bramerhill ClaimsTech
- Captiva InputAccel
- StrataCare StrataWare eReview
- ADP software
- CSC Fault Evaluator
- CAD Zone Insurance
- ARSoftware WinSMAC
- Microsoft Office
- MapScenes Evidence Recorder
- Datanex ClaimTrac
- Turtle Creek Software Goldenseal Architect
- Microsoft Word
- Document management system software
- Automatic Data Processing Claims Manager & Dispatch
- Automatic Data Processing Estimating
- Clear Technology Tranzax
- BCCORP Burkitt W5
- Axonwave Fraud and Abuse Management System
- Property damage, bodily injury, and liability estimation software
- MapScenes Pro
- CCC Pathways Appraisal Quality Solution
- PhotoModeler
- CCC TL2000 Solution
- Magnify Predictive Targeting System
- Bill review software
- First Notice Systems ClaimCapture
- Microsoft Excel
- Agency Management Systems AMS 360
- Castek Insure3 Claims
- CSC Automated Work Distributor AWD
- Brightwork Alyce Claims Systems
- Bridium Claims 3
- CCC GuidePost Decision Support