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