insurance-claims-handler/references/tasks.md

Tasks & work activities — insurance claims handler

Source: O*NET 30.3, occupation 13-1031.00 (Claims Adjusters, Examiners, and Investigators).

Task statements

• [Core] Examine claims forms and other records to determine insurance coverage.
• [Core] Analyze information gathered by investigation and report findings and recommendations.
• [Core] Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
• [Core] Investigate and assess damage to property and create or review property damage estimates.
• [Core] Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
• [Core] Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
• [Core] 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.
• [Core] Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
• [Core] Resolve complex, severe exposure claims, using high service oriented file handling.
• [Core] Pay and process claims within designated authority level.
• [Core] Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
• [Core] 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.
• [Core] Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
• [Core] Refer questionable claims to investigator or claims adjuster for investigation or settlement.
• [Core] Collect evidence to support contested claims in court.
• [Core] Confer with legal counsel on claims requiring litigation.
• [Core] Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
• [Core] Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
• [Core] Present cases and participate in their discussion at claim committee meetings.
• [Core] Report overpayments, underpayments, and other irregularities.
• [Core] Attend mediations or trials.
• [Supplemental] Supervise claims adjusters to ensure that adjusters have followed proper methods.
• [Supplemental] Conduct detailed bill reviews to implement sound litigation management and expense control.
• [Supplemental] Examine titles to property to determine validity and act as company agent in transactions with property owners.
• [Supplemental] Communicate with reinsurance brokers to obtain information necessary for processing claims.
• [Supplemental] Prepare reports to be submitted to company's data processing department.
• [Supplemental] Obtain credit information from banks and other credit services.
• [nan] Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
• [nan] Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.

Detailed work activities

• Advise others on financial matters.
• Advise others on legal or regulatory compliance matters.
• Apply information technology to solve business or other applied problems.
• Appraise property values.
• Calculate data to inform organizational operations.
• Collect evidence for legal proceedings.
• Confer with others about financial matters.
• Estimate costs of goods or services.
• Examine financial records.
• Gather financial records.
• Implement financial decisions.
• Interview witnesses, suspects, or claimants.
• Investigate legal issues.
• Maintain data in information systems or databases.
• Meet with individuals involved in legal processes to provide information and clarify issues.
• Negotiate agreements to resolve disputes.
• Pay charges, fees, or taxes.
• Prepare financial documents.
• Prepare legal or investigatory documentation.
• Prepare operational reports.
• Present business-related information to audiences.
• Report information to managers or other personnel.
• Resolve customer complaints or problems.
• Supervise employees.
• Verify accuracy of records.
• Verify application data to determine program eligibility.