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