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