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