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”
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Collect evidence to support contested claims in court.
- Obtain credit information from banks and other credit services.
- Examine claims forms and other records to determine insurance coverage.
- Prepare report of findings of investigation.
- 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.
- 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.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
Related Technology & Tools
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- Captiva InputAccel
- Automatic Data Processing Claims Manager & Dispatch
- Bill review software
- Microsoft Office
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- CGI INSideOUT
- ISO NetMap for Claims
- Autoclaims Direct DirectLink
- CAD Zone Insurance
- Automatic Data Processing Autosource
- Simsol for Adjusters
- MapScenes Pro
- Agency Management Systems AMS 360
- Axonwave Fraud and Abuse Management System
- CCC EZNet electronic communications network
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- Turtle Creek Software Goldenseal Architect
- Microsoft Word
- ARSoftware WinSMAC
- CCC Pathways Image Management Solution
- Microsoft Excel
- Fair Isaac SmartAdvisor
- Magnify Predictive Targeting System
- IBM Fraud and Abuse Management System
- CSC Colossus
- Bramerhill ClaimsTech
- Hyland OnBase Enterprise Content Management
- CSC Fault Evaluator
- Bridium Claims 3
- CSC Automated Work Distributor AWD
- Claims processing administration and management software
- Automatic Data Processing Estimating
- Hummingbird Legal Bill Review
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- Injury Sciences EDR InSight
- Datanex ClaimTrac
- CCC Pathways Appraisal Quality Solution
- LexisNexis RiskWise
- CCC GuidePost Decision Support
- 4n6xprt Systems StiffCalcs
- Castek Insure3 Claims
- CCC TL2000 Solution
- MapScenes Evidence Recorder
- Property damage, bodily injury, and liability estimation software
- Visual Statement Investigator Suite
- CGI-AMS BureauLink Enterprise
- ADP software
- Corporate Systems ClaimsPro
- Brightwork Alyce Claims Systems
- StrataCare StrataWare eReview
- BCCORP Burkitt W5
- ISO ClaimSearch
- First Notice Systems ClaimCapture
- Clear Technology Tranzax
- Document management system software