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