Will “Medical Claims Analyst” 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
- 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 “Medical Claims Analyst”
- Obtain credit information from banks and other credit services.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- 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.
- Investigate and assess damage to property and create or review property damage estimates.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Examine claims forms and other records to determine insurance coverage.
- 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.
- Analyze information gathered by investigation and report findings and recommendations.
- Prepare report of findings of investigation.
- Collect evidence to support contested claims in court.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
Related Technology & Tools
- Personal digital assistants PDA
- Handheld computers
- Measure markers
- Data collectors
- Field computers
- Total stations
- Mobile wireless handheld communication devices
- Desktop computers
- Event data recorders
- Autoclaims Direct DirectLink
- Automatic Data Processing Autosource
- CCC TL2000 Solution
- CSC Automated Work Distributor AWD
- Property damage, bodily injury, and liability estimation software
- Computerized voice stress analyzer CVSA software
- MapScenes Pro
- CCC Pathways Appraisal Quality Solution
- Microsoft Office
- LexisNexis RiskWise
- QwikQuote software
- MapScenes Evidence Recorder
- Brightwork Alyce Claims Systems
- StrataCare StrataWare eReview
- CAD Zone Insurance
- Covansys ClaimConnect
- Axonwave Fraud and Abuse Management System
- Hyland OnBase Enterprise Content Management
- CSC Colossus
- CGI INSideOUT
- Hummingbird Legal Bill Review
- Bramerhill ClaimsTech
- Microsoft Word
- ISO ClaimSearch
- Corporate Systems ClaimsPro
- ADP software
- IBM Fraud and Abuse Management System
- CCC EZNet electronic communications network
- Automatic Data Processing Estimating
- CCC Pathways Image Management Solution
- Visual Statement Investigator Suite
- ISO NetMap for Claims
- Simsol for Adjusters
- CGI-AMS BureauLink Enterprise
- Captiva InputAccel
- ARSoftware WinSMAC
- Turtle Creek Software Goldenseal Architect
- 4n6xprt Systems StiffCalcs
- PhotoModeler
- BCCORP Burkitt W5
- Castek Insure3 Claims
- First Notice Systems ClaimCapture
- Automatic Data Processing Claims Manager & Dispatch
- Injury Sciences EDR InSight
- Document management system software
- CCC GuidePost Decision Support
- Microsoft Excel
- Insurance claims fraud detection software
- Bridium Claims 3
- Agency Management Systems AMS 360
- Magnify Predictive Targeting System
- Claims processing administration and management software
- CSC Fault Evaluator
- Datanex ClaimTrac
- Fair Isaac SmartAdvisor
- InSystems Calligo Document Management System
- Clear Technology Tranzax
- Bill review software