Will “Claim Specialist” 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 Processor
- Claim Investigator
- Claim Inspector
- Claim Examiner
- 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 Specialist”
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Examine claims forms and other records to determine insurance coverage.
- Obtain credit information from banks and other credit services.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Collect evidence to support contested claims in court.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Prepare report of findings of investigation.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Analyze information gathered by investigation and report findings and recommendations.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- Investigate and assess damage to property and create or review property damage estimates.
Related Technology & Tools
- Desktop computers
- Measure markers
- Data collectors
- Event data recorders
- Field computers
- Total stations
- Personal digital assistants PDA
- Handheld computers
- Mobile wireless handheld communication devices
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- Visual Statement Investigator Suite
- CSC Fault Evaluator
- CSC Automated Work Distributor AWD
- ARSoftware WinSMAC
- CCC TL2000 Solution
- Injury Sciences EDR InSight
- Magnify Predictive Targeting System
- LexisNexis RiskWise
- CCC Pathways Image Management Solution
- CAD Zone Insurance
- Agency Management Systems AMS 360
- Insurance claims fraud detection software
- Castek Insure3 Claims
- MapScenes Pro
- ADP software
- MapScenes Evidence Recorder
- Computerized voice stress analyzer CVSA software
- Bramerhill ClaimsTech
- IBM Fraud and Abuse Management System
- QwikQuote software
- InSystems Calligo Document Management System
- Microsoft Office
- Document management system software
- Microsoft Word
- Datanex ClaimTrac
- Property damage, bodily injury, and liability estimation software
- CSC Colossus
- BCCORP Burkitt W5
- Claims processing administration and management software
- Covansys ClaimConnect
- CCC Pathways Appraisal Quality Solution
- CGI INSideOUT
- Clear Technology Tranzax
- Automatic Data Processing Claims Manager & Dispatch
- Microsoft Excel
- PhotoModeler
- Bill review software
- Hummingbird Legal Bill Review
- Autoclaims Direct DirectLink
- Brightwork Alyce Claims Systems
- Axonwave Fraud and Abuse Management System
- 4n6xprt Systems StiffCalcs
- CGI-AMS BureauLink Enterprise
- Hyland OnBase Enterprise Content Management
- Automatic Data Processing Estimating
- Corporate Systems ClaimsPro
- Fair Isaac SmartAdvisor
- Captiva InputAccel
- Simsol for Adjusters
- Automatic Data Processing Autosource
- CCC GuidePost Decision Support
- First Notice Systems ClaimCapture
- CCC EZNet electronic communications network
- Turtle Creek Software Goldenseal Architect
- ISO NetMap for Claims
- Bridium Claims 3
- ISO ClaimSearch