Will “Claims Adjuster” be Replaced By Robots? 🤔
Unknown Chance of Automation
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Job Description
Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.
Job Details
- The SOC (Standard Occupational Classification) code is 13-1031.01
☝️ Information based on the reference occupation “Claims Examiners, Property and Casualty Insurance”.
Also Known As…
- Claims Examiners, Property and Casualty Insurance
- Home Office Claim Specialist
- Customer Care Specialist
- Corporate Claims Examiner
- Claims Supervisor
- Claims Specialist
- Claims Representative
- Claims Manager
- Claims Examiner
- Claims Analyst
- Workers Compensation Examiner
- Workers Compensation Claims Examiner
- Worker's Compensation Claims Examiner
- Reinsurance Claim Analyst
- Property Damage Claims Adjustor
- Litigation Examiner
- Liability Claims Representative
- Liability Claims Manager
- Liability Claims Examiner
- Insurance Examiner
- Insurance Auditor
- Home Office Claims Examiner
- Executive Relations Specialist
- Claims Vice President
- Claims Director
- Claims Consultant
- Claims Auditor
- Claims Adjuster
- Claims Account Specialist
- Claims Account Manager
- Claim Auditor
- Check Examiner
- Casualty Claims Supervisor
- Case Manager
Tasks for “Claims Adjuster”
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Present cases and participate in their discussion at claim committee meetings.
- Prepare reports to be submitted to company's data processing department.
- Confer with legal counsel on claims requiring litigation.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Report overpayments, underpayments, and other irregularities.
- Pay and process claims within designated authority level.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Related Technology & Tools
- Tablet computers
- Scanners
- Desktop computers
- Personal digital assistants PDA
- Notebook computers
- Personal computers
- CCC EZNet electronic communications network
- IBM Fraud and Abuse Management System
- Medical procedure coding software
- BCCORP W5 for Adjusters
- Bill review software
- Corporate Systems ClaimsPro
- Tropics Claims Reserve Management
- Medical condition coding software
- CCC TL2000 Solution
- Covansys ClaimConnect
- Computerized voice stress analyzer CVSA software
- ISO ClaimSearch
- CCC Pathways Appraisal Quality Solution
- Axonwave Fraud and Abuse Management System
- Captiva InputAccel
- Hyland OnBase Enterprise Content Management
- Magnify Predictive Targeting System
- Bridium Claims 3
- Microsoft Word
- CSC Fault Evaluator
- LexisNexis RiskWise
- Microsoft Office
- Insurance claims fraud detection software
- Fair Isaac Claims Advisor
- Microsoft Excel
- StrataCare StrataWare eReview
- AutoClaims Direct DirectLink
- Agency Management Systems AMS 360
- First Notice Systems ClaimCapture
- Bramerhill ClaimsTech
- ISO NetMap for Claims
- Clear Technology Tranzax
- InSystems Calligo Document Management System
- CCC GuidePost Decision Support
- Automatic Data Processing Claims Manager & Dispatch
- CCC Pathways Image Management Solution
- Microsoft PowerPoint
- Castek Insure3 Claims
- Document management system software
- Claims processing administration and management software
- Hummingbird Legal Bill Review
- Healthcare common procedure coding system HCPCS
- Datanex ClaimTrac
- Automatic Data Processing Autosource
- Fair Isaac SmartAdvisor
- CSC Automated Work Distributor AWD
- Brightwork Alyce Claims Systems
- CGI INSideOUT