Will “Claims Specialist” be Replaced By Robots? 🤔
Unknown Chance of Automation
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Job Description
Investigate, analyze, and determine the extent of insurance company's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.
Job Details
- The SOC (Standard Occupational Classification) code is 13-1031.02
☝️ Information based on the reference occupation “Insurance Adjusters, Examiners, and Investigators”.
Also Known As…
- Insurance Adjusters, Examiners, and Investigators
- Litigation Claim Representative
- Independent Insurance Adjuster
- General Adjuster
- Field Liability Generalist
- Claims Representative
- Claims Examiner
- Claims Analyst
- Claims Adjuster
- Claim Representative
- Workers Compensation Claims Adjuster
- Telephone Claims Representative
- Salvage Determiner
- Residential Insurance Inspector
- Property Claims Adjuster
- Property Adjuster
- Multi-line Claims Adjuster
- Medical Claims Specialist
- Medical Claims Examiner
- Medical Claims Analyst
- Material Damage Adjuster
- Job Estimator
- Investigator
- Insurance Inspector
- Insurance Claims Adjuster
- Insurance Appraiser
- Insurance Adjuster
- Inspector
- Health Claims Examiner
- Fire Adjuster
- Field Adjuster
- Examiner
- Estimator
- Disability Specialist
- Disability Examiner
- Compensation Adjuster
- Clerical Adjuster
- Claims Specialist
- Claims Service Adjustor
- Claims Manager
- Claims Assistant
- Claims Adjustor
- Claim Specialist
- Claim Processor
- Claim Investigator
- Claim Inspector
- Claim Examiner
- Claim Approver
- Claim Agent
- Claim Adjuster
- Catastrophe Claims Supervisor
- Building Appraiser
- Bodily Injury Adjuster
- Benefit Authorizer
- Auto Claims Adjuster
- Arson Investigator
- Appraiser
- Adjustment Clerk
- Adjuster
- Accident Investigator
Tasks for “Claims Specialist”
- Collect evidence to support contested claims in court.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Analyze information gathered by investigation and report findings and recommendations.
- Prepare report of findings of investigation.
- Examine claims forms and other records to determine insurance coverage.
- Investigate and assess damage to property and create or review property damage estimates.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Obtain credit information from banks and other credit services.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
Related Technology & Tools
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- Personal digital assistants PDA
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- Desktop computers
- Field computers
- Data collectors
- Measure markers
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- CCC TL2000 Solution
- MapScenes Pro
- Agency Management Systems AMS 360
- Claims processing administration and management software
- Automatic Data Processing Estimating
- Hummingbird Legal Bill Review
- Clear Technology Tranzax
- CCC Pathways Appraisal Quality Solution
- Datanex ClaimTrac
- Autoclaims Direct DirectLink
- Microsoft Office
- Microsoft Word
- ISO NetMap for Claims
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- Simsol for Adjusters
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- Axonwave Fraud and Abuse Management System
- 4n6xprt Systems StiffCalcs
- MapScenes Evidence Recorder
- Bill review software
- First Notice Systems ClaimCapture
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- Automatic Data Processing Claims Manager & Dispatch
- CAD Zone Insurance
- CCC Pathways Image Management Solution
- CGI-AMS BureauLink Enterprise
- CGI INSideOUT
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- Computerized voice stress analyzer CVSA software
- Visual Statement Investigator Suite
- StrataCare StrataWare eReview
- Microsoft Excel
- IBM Fraud and Abuse Management System
- ARSoftware WinSMAC
- Document management system software
- ADP software
- Injury Sciences EDR InSight
- Castek Insure3 Claims
- CSC Fault Evaluator
- Bridium Claims 3
- CSC Colossus
- Hyland OnBase Enterprise Content Management
- Automatic Data Processing Autosource
- Fair Isaac SmartAdvisor
- ISO ClaimSearch
- Insurance claims fraud detection software
- CCC EZNet electronic communications network
- Corporate Systems ClaimsPro
- CSC Automated Work Distributor AWD
- Turtle Creek Software Goldenseal Architect
- Covansys ClaimConnect
- InSystems Calligo Document Management System
- BCCORP Burkitt W5
- Captiva InputAccel
- LexisNexis RiskWise