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