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