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