Will “Health 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
- 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 “Health Claims Examiner”
- 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.
- Collect evidence to support contested claims in court.
- Prepare report of findings of investigation.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- 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.
- 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.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Obtain credit information from banks and other credit services.
- 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
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- Mobile wireless handheld communication devices
- Measure markers
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- CCC Pathways Appraisal Quality Solution
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- Visual Statement Investigator Suite
- CAD Zone Insurance
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- CSC Fault Evaluator
- Property damage, bodily injury, and liability estimation software
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- Automatic Data Processing Autosource
- CSC Automated Work Distributor AWD
- Automatic Data Processing Estimating
- PhotoModeler
- MapScenes Pro
- Hummingbird Legal Bill Review
- IBM Fraud and Abuse Management System
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- Microsoft Word
- Computerized voice stress analyzer CVSA software
- Datanex ClaimTrac
- InSystems Calligo Document Management System
- Automatic Data Processing Claims Manager & Dispatch
- CSC Colossus
- Turtle Creek Software Goldenseal Architect
- Castek Insure3 Claims
- Magnify Predictive Targeting System
- LexisNexis RiskWise
- BCCORP Burkitt W5
- Bridium Claims 3
- Microsoft Office
- CCC EZNet electronic communications network
- Hyland OnBase Enterprise Content Management
- CCC TL2000 Solution
- Corporate Systems ClaimsPro
- Brightwork Alyce Claims Systems
- Captiva InputAccel
- ISO ClaimSearch
- Fair Isaac SmartAdvisor
- Microsoft Excel
- Bill review software
- Bramerhill ClaimsTech
- Agency Management Systems AMS 360
- StrataCare StrataWare eReview
- QwikQuote software
- CGI-AMS BureauLink Enterprise
- First Notice Systems ClaimCapture
- 4n6xprt Systems StiffCalcs
- MapScenes Evidence Recorder
- Autoclaims Direct DirectLink
- ARSoftware WinSMAC
- ISO NetMap for Claims