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