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