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