Will “Corporate Claims Examiner” be Replaced By Robots? 🤔
Unknown Chance of Automation
Sadly, the research paper did not provide any information about this occupation. Maybe have a look at our directory?
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”
- 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.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Confer with legal counsel on claims requiring litigation.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Pay and process claims within designated authority level.
- Present cases and participate in their discussion at claim committee meetings.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- 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.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Prepare reports to be submitted to company's data processing department.
- Report overpayments, underpayments, and other irregularities.
Related Technology & Tools
- Personal computers
- Tablet computers
- Scanners
- Personal digital assistants PDA
- Notebook computers
- Desktop computers
- Tropics Claims Reserve Management
- Datanex ClaimTrac
- Agency Management Systems AMS 360
- ISO ClaimSearch
- CCC Pathways Image Management Solution
- ISO NetMap for Claims
- Bramerhill ClaimsTech
- Corporate Systems ClaimsPro
- AutoClaims Direct DirectLink
- Healthcare common procedure coding system HCPCS
- InSystems Calligo Document Management System
- Medical condition coding software
- CGI INSideOUT
- First Notice Systems ClaimCapture
- Hummingbird Legal Bill Review
- Captiva InputAccel
- Bill review software
- IBM Fraud and Abuse Management System
- Clear Technology Tranzax
- Microsoft PowerPoint
- BCCORP W5 for Adjusters
- Automatic Data Processing Claims Manager & Dispatch
- Axonwave Fraud and Abuse Management System
- CCC EZNet electronic communications network
- Castek Insure3 Claims
- Claims processing administration and management software
- Medical procedure coding software
- Brightwork Alyce Claims Systems
- Hyland OnBase Enterprise Content Management
- CCC TL2000 Solution
- Fair Isaac Claims Advisor
- Magnify Predictive Targeting System
- Document management system software
- Microsoft Word
- Computerized voice stress analyzer CVSA software
- CSC Fault Evaluator
- Covansys ClaimConnect
- Automatic Data Processing Autosource
- Insurance claims fraud detection software
- Fair Isaac SmartAdvisor
- StrataCare StrataWare eReview
- Microsoft Excel
- LexisNexis RiskWise
- CCC Pathways Appraisal Quality Solution
- CSC Automated Work Distributor AWD
- CCC GuidePost Decision Support
- Microsoft Office
- Bridium Claims 3