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