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