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”
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Present cases and participate in their discussion at claim committee meetings.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Pay and process claims within designated authority level.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- 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.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Report overpayments, underpayments, and other irregularities.
- 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.
- Prepare reports to be submitted to company's data processing department.
Related Technology & Tools
- Scanners
- Notebook computers
- Personal computers
- Desktop computers
- Personal digital assistants PDA
- Tablet computers
- Healthcare common procedure coding system HCPCS
- StrataCare StrataWare eReview
- Claims processing administration and management software
- Computerized voice stress analyzer CVSA software
- Microsoft Excel
- Brightwork Alyce Claims Systems
- Microsoft PowerPoint
- LexisNexis RiskWise
- Captiva InputAccel
- Insurance claims fraud detection software
- Automatic Data Processing Autosource
- CCC GuidePost Decision Support
- AutoClaims Direct DirectLink
- Agency Management Systems AMS 360
- Castek Insure3 Claims
- Document management system software
- Microsoft Office
- Magnify Predictive Targeting System
- ISO NetMap for Claims
- Axonwave Fraud and Abuse Management System
- BCCORP W5 for Adjusters
- Bill review software
- CGI INSideOUT
- Clear Technology Tranzax
- Hyland OnBase Enterprise Content Management
- Microsoft Word
- Corporate Systems ClaimsPro
- Medical condition coding software
- IBM Fraud and Abuse Management System
- Covansys ClaimConnect
- Hummingbird Legal Bill Review
- CCC TL2000 Solution
- First Notice Systems ClaimCapture
- Bramerhill ClaimsTech
- Fair Isaac SmartAdvisor
- InSystems Calligo Document Management System
- Datanex ClaimTrac
- CSC Fault Evaluator
- CCC Pathways Image Management Solution
- ISO ClaimSearch
- Fair Isaac Claims Advisor
- Tropics Claims Reserve Management
- CCC EZNet electronic communications network
- CCC Pathways Appraisal Quality Solution
- Medical procedure coding software
- Automatic Data Processing Claims Manager & Dispatch
- CSC Automated Work Distributor AWD
- Bridium Claims 3