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