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