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