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”
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- 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.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Examine claims forms and other records to determine insurance coverage.
- Obtain credit information from banks and other credit services.
- Communicate with former associates to verify employment record and to obtain background information regarding persons or businesses applying for credit.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Collect evidence to support contested claims in court.
- Investigate and assess damage to property and create or review property damage estimates.
- Prepare report of findings of investigation.
Related Technology & Tools
- Total stations
- Desktop computers
- Field computers
- Personal digital assistants PDA
- Mobile wireless handheld communication devices
- Event data recorders
- Measure markers
- Data collectors
- Handheld computers
- Bill review software
- Document management system software
- CCC Pathways Appraisal Quality Solution
- Covansys ClaimConnect
- CGI INSideOUT
- Datanex ClaimTrac
- CCC GuidePost Decision Support
- Microsoft Word
- Turtle Creek Software Goldenseal Architect
- PhotoModeler
- Fair Isaac SmartAdvisor
- IBM Fraud and Abuse Management System
- Claims processing administration and management software
- First Notice Systems ClaimCapture
- InSystems Calligo Document Management System
- CSC Fault Evaluator
- Property damage, bodily injury, and liability estimation software
- Clear Technology Tranzax
- Corporate Systems ClaimsPro
- Injury Sciences EDR InSight
- Bramerhill ClaimsTech
- QwikQuote software
- MapScenes Pro
- Axonwave Fraud and Abuse Management System
- Microsoft Excel
- 4n6xprt Systems StiffCalcs
- Automatic Data Processing Claims Manager & Dispatch
- Captiva InputAccel
- CCC TL2000 Solution
- CGI-AMS BureauLink Enterprise
- Visual Statement Investigator Suite
- CSC Colossus
- MapScenes Evidence Recorder
- Microsoft Office
- ISO ClaimSearch
- ISO NetMap for Claims
- ARSoftware WinSMAC
- Computerized voice stress analyzer CVSA software
- Agency Management Systems AMS 360
- Bridium Claims 3
- CCC EZNet electronic communications network
- ADP software
- CAD Zone Insurance
- CSC Automated Work Distributor AWD
- Simsol for Adjusters
- Hummingbird Legal Bill Review
- BCCORP Burkitt W5
- Brightwork Alyce Claims Systems
- Autoclaims Direct DirectLink
- CCC Pathways Image Management Solution
- Automatic Data Processing Autosource
- Hyland OnBase Enterprise Content Management
- Automatic Data Processing Estimating
- LexisNexis RiskWise
- Magnify Predictive Targeting System
- Castek Insure3 Claims
- Insurance claims fraud detection software
- StrataCare StrataWare eReview