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