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