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