Will “Claims 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 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 “Claims Examiner”
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Investigate and assess damage to property and create or review property damage estimates.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- 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.
- Prepare report of findings of investigation.
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Obtain credit information from banks and other credit services.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- Collect evidence to support contested claims in court.
Related Technology & Tools
- Handheld computers
- Event data recorders
- Personal digital assistants PDA
- Field computers
- Data collectors
- Total stations
- Measure markers
- Mobile wireless handheld communication devices
- Desktop computers
- Simsol for Adjusters
- Autoclaims Direct DirectLink
- Bridium Claims 3
- Injury Sciences EDR InSight
- ADP software
- Insurance claims fraud detection software
- Magnify Predictive Targeting System
- CSC Fault Evaluator
- CCC Pathways Appraisal Quality Solution
- Microsoft Word
- Hummingbird Legal Bill Review
- Property damage, bodily injury, and liability estimation software
- Bramerhill ClaimsTech
- IBM Fraud and Abuse Management System
- CSC Colossus
- CCC EZNet electronic communications network
- Agency Management Systems AMS 360
- CCC TL2000 Solution
- LexisNexis RiskWise
- Hyland OnBase Enterprise Content Management
- QwikQuote software
- Covansys ClaimConnect
- Computerized voice stress analyzer CVSA software
- ISO ClaimSearch
- 4n6xprt Systems StiffCalcs
- Corporate Systems ClaimsPro
- Visual Statement Investigator Suite
- CAD Zone Insurance
- Fair Isaac SmartAdvisor
- Datanex ClaimTrac
- Captiva InputAccel
- Microsoft Excel
- Turtle Creek Software Goldenseal Architect
- CGI-AMS BureauLink Enterprise
- Clear Technology Tranzax
- Bill review software
- BCCORP Burkitt W5
- CGI INSideOUT
- ARSoftware WinSMAC
- Document management system software
- Brightwork Alyce Claims Systems
- Axonwave Fraud and Abuse Management System
- Claims processing administration and management software
- MapScenes Pro
- Automatic Data Processing Claims Manager & Dispatch
- Castek Insure3 Claims
- MapScenes Evidence Recorder
- InSystems Calligo Document Management System
- Automatic Data Processing Estimating
- StrataCare StrataWare eReview
- CCC Pathways Image Management Solution
- Microsoft Office
- CSC Automated Work Distributor AWD
- Automatic Data Processing Autosource
- PhotoModeler
- ISO NetMap for Claims
- CCC GuidePost Decision Support
- First Notice Systems ClaimCapture