Will “Medical 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 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 “Medical Claims Examiner”
- 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.
- Collect evidence to support contested claims in court.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- 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.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- 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.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Obtain credit information from banks and other credit services.
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- CGI INSideOUT
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- ISO NetMap for Claims
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- Automatic Data Processing Estimating
- CAD Zone Insurance
- Microsoft Office
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- ARSoftware WinSMAC
- CSC Automated Work Distributor AWD
- Hyland OnBase Enterprise Content Management
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- Turtle Creek Software Goldenseal Architect
- Autoclaims Direct DirectLink
- 4n6xprt Systems StiffCalcs
- QwikQuote software
- Clear Technology Tranzax
- InSystems Calligo Document Management System
- Visual Statement Investigator Suite
- Microsoft Excel
- Bridium Claims 3
- CCC TL2000 Solution
- BCCORP Burkitt W5
- Automatic Data Processing Autosource
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- CGI-AMS BureauLink Enterprise
- Castek Insure3 Claims
- Injury Sciences EDR InSight
- LexisNexis RiskWise