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Summary Job Description | Tasks | |||
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. | 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. | |||
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Pay and process claims within designated authority level. | ||||
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Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. | ||||
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Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. | ||||
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Resolve complex, severe exposure claims, using high service oriented file handling. | ||||
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Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis. | ||||
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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. | ||||
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Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. | ||||
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Present cases and participate in their discussion at claim committee meetings. | ||||
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Contact or interview claimants, doctors, medical specialists, or employers to get additional information. | ||||
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Confer with legal counsel on claims requiring litigation. | ||||
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Report overpayments, underpayments, and other irregularities. | ||||
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Communicate with reinsurance brokers to obtain information necessary for processing claims. | ||||
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Supervise claims adjusters to ensure that adjusters have followed proper methods. | ||||
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Conduct detailed bill reviews to implement sound litigation management and expense control. | ||||
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Prepare reports to be submitted to company's data processing department. | ||||
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CompGeo Salary Survey Benchmark Job Summary and Competencies
Claims Examiners, Property and Casualty Insurance
The Benchmark Job Description below represents the specific Position Characteristics of the job used in the Salary Survey. Benchmark Job Descriptions should be inspected carefully to review the degree of matching between an organizations' Job and the Salary Survey Benchmark. Matching internal Jobs to Salary Survey Benchmark Jobs should not be done on Job Title alone. A thorough comparison of Salary Survey Benchmark to Internal Job Descriptions is recommended. A good overlap should exist on any comparisons used on critical Job Dimensions and Competencies.- Job Description
- Knowledges
- Skills
- Abilites
- Tools and Technology
- Education and Experience
- Alternate Job Titles
- Salaries
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Important Knowledge Competencies | Competency Description | |||
Customer and Personal Service | Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. | |||
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English Language | Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. | |||
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Law and Government | Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process. | |||
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Administration and Management | Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources. | |||
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Clerical | Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology. | |||
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Computers and Electronics | Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming. | |||
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Mathematics | Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications. | |||
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Important Skill Competencies | Competency Description | |||
Reading Comprehension | Understanding written sentences and paragraphs in work related documents. | |||
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Writing | Communicating effectively in writing as appropriate for the needs of the audience. | |||
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Active Listening | Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. | |||
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Speaking | Talking to others to convey information effectively. | |||
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Critical Thinking | Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. | |||
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Negotiation | Bringing others together and trying to reconcile differences. | |||
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Judgment and Decision Making | Considering the relative costs and benefits of potential actions to choose the most appropriate one. | |||
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Monitoring | Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action. | |||
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Social Perceptiveness | Being aware of others' reactions and understanding why they react as they do. | |||
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Complex Problem Solving | Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. | |||
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Active Learning | Understanding the implications of new information for both current and future problem-solving and decision-making. | |||
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Coordination | Adjusting actions in relation to others' actions. | |||
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Service Orientation | Actively looking for ways to help people. | |||
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Persuasion | Persuading others to change their minds or behavior. | |||
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Time Management | Managing one's own time and the time of others. | |||
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Mathematics | Using mathematics to solve problems. | |||
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Instructing | Teaching others how to do something. | |||
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Systems Analysis | Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes. | |||
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Management of Personnel Resources | Motivating, developing, and directing people as they work, identifying the best people for the job. | |||
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Important Ability Competencies | Competency Description | |||
Oral Comprehension | The ability to listen to and understand information and ideas presented through spoken words and sentences. | |||
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Written Comprehension | The ability to read and understand information and ideas presented in writing. | |||
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Oral Expression | The ability to communicate information and ideas in speaking so others will understand. | |||
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Deductive Reasoning | The ability to apply general rules to specific problems to produce answers that make sense. | |||
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Problem Sensitivity | The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem. | |||
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Written Expression | The ability to communicate information and ideas in writing so others will understand. | |||
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Inductive Reasoning | The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events). | |||
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Speech Recognition | The ability to identify and understand the speech of another person. | |||
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Speech Clarity | The ability to speak clearly so others can understand you. | |||
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Information Ordering | The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations). | |||
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Near Vision | The ability to see details at close range (within a few feet of the observer). | |||
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Category Flexibility | The ability to generate or use different sets of rules for combining or grouping things in different ways. | |||
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Mathematical Reasoning | The ability to choose the right mathematical methods or formulas to solve a problem. | |||
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Selective Attention | The ability to concentrate on a task over a period of time without being distracted. | |||
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Fluency of Ideas | The ability to come up with a number of ideas about a topic (the number of ideas is important, not their quality, correctness, or creativity). | |||
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Originality | The ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem. | |||
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Number Facility | The ability to add, subtract, multiply, or divide quickly and correctly. | |||
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Flexibility of Closure | The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material. | |||
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Perceptual Speed | The ability to quickly and accurately compare similarities and differences among sets of letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object. | |||
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Time Sharing | The ability to shift back and forth between two or more activities or sources of information (such as speech, sounds, touch, or other sources). | |||
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Far Vision | The ability to see details at a distance. | |||
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Tools/Technology Example | Product Category | |||
Agency Management Systems AMS 360 | Document management software | |||
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AutoClaims Direct DirectLink | Document management software | |||
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Automatic Data Processing Autosource | Document management software | |||
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Automatic Data Processing Claims Manager & Dispatch | Document management software | |||
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Axonwave Fraud and Abuse Management System | Expert system software | |||
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BCCORP W5 for Adjusters | Document management software | |||
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Bill review software | Expert system software | |||
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Bramerhill ClaimsTech | Document management software | |||
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Bridium Claims 3 | Document management software | |||
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Brightwork Alyce Claims Systems | Document management software | |||
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CCC EZNet electronic communications network | Access software | |||
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CCC GuidePost Decision Support | Expert system software | |||
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CCC Pathways Appraisal Quality Solution | Enterprise resource planning ERP software | |||
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CCC Pathways Image Management Solution | Document management software | |||
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CCC TL2000 Solution | Document management software | |||
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CGI INSideOUT | Document management software | |||
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CSC Automated Work Distributor AWD | Access software | |||
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CSC Fault Evaluator | Expert system software | |||
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Captiva InputAccel | Document management software | |||
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Castek Insure3 Claims | Document management software | |||
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Claims processing administration and management software | Data base user interface and query software | |||
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Clear Technology Tranzax | Document management software | |||
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Computerized voice stress analyzer CVSA software | Interactive voice response software | |||
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Corporate Systems ClaimsPro | Data base reporting software | |||
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Covansys ClaimConnect | Document management software | |||
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Datanex ClaimTrac | Document management software | |||
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Document management system software | Document management software | |||
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Fair Isaac Claims Advisor | Data base user interface and query software | |||
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Fair Isaac SmartAdvisor | Expert system software | |||
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First Notice Systems ClaimCapture | Expert system software | |||
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Hummingbird Legal Bill Review | Expert system software | |||
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Hyland OnBase Enterprise Content Management | Document management software | |||
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IBM Fraud and Abuse Management System | Expert system software | |||
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ISO ClaimSearch | Expert system software | |||
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ISO NetMap for Claims | Expert system software | |||
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InSystems Calligo Document Management System | Document management software | |||
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Insurance claims fraud detection software | Analytical or scientific software | |||
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LexisNexis RiskWise | Expert system software | |||
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Magnify Predictive Targeting System | Analytical or scientific software | |||
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StrataCare StrataWare eReview | Expert system software | |||
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Tropics Claims Reserve Management | Data base user interface and query software | |||
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atGlobal Allegro | Document management software | |||
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atGlobal webMBR | Expert system software | |||
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atGlobal webReports | Document management software | |||
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Desktop computers | Desktop computers | |||
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Notebook computers | Notebook computers | |||
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Personal computers | Personal computers | |||
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Personal digital assistants PDA | Personal digital assistant PDAs or organizers | |||
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Scanners | Scanners | |||
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Tablet computers | Tablet computers | |||
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Prerequisite Qualification Category | Education and Experience Level | |||
Required Level of Education | Bachelor's Degree | |||
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Alternate Job Title(s) | |||
Case Manager | |||
Casualty Claims Supervisor | |||
Check Examiner | |||
Claim Auditor | |||
Claims Account Manager | |||
Claims Account Specialist | |||
Claims Adjuster | |||
Claims Analyst | |||
Claims Auditor | |||
Claims Director | |||
Claims Examiner | |||
Claims Manager | |||
Claims Representative | |||
Claims Specialist | |||
Claims Supervisor | |||
Claims Vice President | |||
Corporate Claims Examiner | |||
Customer Care Specialist | |||
Executive Relations Specialist | |||
Home Office Claim Specialist | |||
Home Office Claims Examiner | |||
Insurance Auditor | |||
Insurance Examiner | |||
Liability Claims Examiner | |||
Liability Claims Manager | |||
Liability Claims Representative | |||
Litigation Examiner | |||
Property Damage Claims Adjustor | |||
Reinsurance Claim Analyst | |||
Worker's Compensation Claims Examiner | |||
Workers Compensation Claims Examiner | |||
Workers Compensation Examiner | |||
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