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.
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
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.
 
Pay and process claims within designated authority level.
 
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.
 
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.
 
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
 
Present cases and participate in their discussion at claim committee meetings.
 
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
 
Confer with legal counsel on claims requiring litigation.
 
Report overpayments, underpayments, and other irregularities.
 
Communicate with reinsurance brokers to obtain information necessary for processing claims.
 
Supervise claims adjusters to ensure that adjusters have followed proper methods.
 
Conduct detailed bill reviews to implement sound litigation management and expense control.
 
Prepare reports to be submitted to company's data processing department.
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
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.
 
English Language Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
 
Law and Government Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
 
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.
 
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.
 
Computers and Electronics Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
 
Mathematics Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
Important Skill Competencies Competency Description
Reading Comprehension Understanding written sentences and paragraphs in work related documents.
 
Writing Communicating effectively in writing as appropriate for the needs of the audience.
 
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.
 
Speaking Talking to others to convey information effectively.
 
Critical Thinking Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
 
Negotiation Bringing others together and trying to reconcile differences.
 
Judgment and Decision Making Considering the relative costs and benefits of potential actions to choose the most appropriate one.
 
Monitoring Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
 
Social Perceptiveness Being aware of others' reactions and understanding why they react as they do.
 
Complex Problem Solving Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
 
Active Learning Understanding the implications of new information for both current and future problem-solving and decision-making.
 
Coordination Adjusting actions in relation to others' actions.
 
Service Orientation Actively looking for ways to help people.
 
Persuasion Persuading others to change their minds or behavior.
 
Time Management Managing one's own time and the time of others.
 
Mathematics Using mathematics to solve problems.
 
Instructing Teaching others how to do something.
 
Systems Analysis Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.
 
Management of Personnel Resources Motivating, developing, and directing people as they work, identifying the best people for the job.
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
Important Ability Competencies Competency Description
Oral Comprehension The ability to listen to and understand information and ideas presented through spoken words and sentences.
 
Written Comprehension The ability to read and understand information and ideas presented in writing.
 
Oral Expression The ability to communicate information and ideas in speaking so others will understand.
 
Deductive Reasoning The ability to apply general rules to specific problems to produce answers that make sense.
 
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.
 
Written Expression The ability to communicate information and ideas in writing so others will understand.
 
Inductive Reasoning The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
 
Speech Recognition The ability to identify and understand the speech of another person.
 
Speech Clarity The ability to speak clearly so others can understand you.
 
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).
 
Near Vision The ability to see details at close range (within a few feet of the observer).
 
Category Flexibility The ability to generate or use different sets of rules for combining or grouping things in different ways.
 
Mathematical Reasoning The ability to choose the right mathematical methods or formulas to solve a problem.
 
Selective Attention The ability to concentrate on a task over a period of time without being distracted.
 
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).
 
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.
 
Number Facility The ability to add, subtract, multiply, or divide quickly and correctly.
 
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.
 
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.
 
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).
 
Far Vision The ability to see details at a distance.
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
Tools/Technology Example Product Category
Agency Management Systems AMS 360 Document management software
 
AutoClaims Direct DirectLink Document management software
 
Automatic Data Processing Autosource Document management software
 
Automatic Data Processing Claims Manager & Dispatch Document management software
 
Axonwave Fraud and Abuse Management System Expert system software
 
BCCORP W5 for Adjusters Document management software
 
Bill review software Expert system software
 
Bramerhill ClaimsTech Document management software
 
Bridium Claims 3 Document management software
 
Brightwork Alyce Claims Systems Document management software
 
CCC EZNet electronic communications network Access software
 
CCC GuidePost Decision Support Expert system software
 
CCC Pathways Appraisal Quality Solution Enterprise resource planning ERP software
 
CCC Pathways Image Management Solution Document management software
 
CCC TL2000 Solution Document management software
 
CGI INSideOUT Document management software
 
CSC Automated Work Distributor AWD Access software
 
CSC Fault Evaluator Expert system software
 
Captiva InputAccel Document management software
 
Castek Insure3 Claims Document management software
 
Claims processing administration and management software Data base user interface and query software
 
Clear Technology Tranzax Document management software
 
Computerized voice stress analyzer CVSA software Interactive voice response software
 
Corporate Systems ClaimsPro Data base reporting software
 
Covansys ClaimConnect Document management software
 
Datanex ClaimTrac Document management software
 
Document management system software Document management software
 
Fair Isaac Claims Advisor Data base user interface and query software
 
Fair Isaac SmartAdvisor Expert system software
 
First Notice Systems ClaimCapture Expert system software
 
Hummingbird Legal Bill Review Expert system software
 
Hyland OnBase Enterprise Content Management Document management software
 
IBM Fraud and Abuse Management System Expert system software
 
ISO ClaimSearch Expert system software
 
ISO NetMap for Claims Expert system software
 
InSystems Calligo Document Management System Document management software
 
Insurance claims fraud detection software Analytical or scientific software
 
LexisNexis RiskWise Expert system software
 
Magnify Predictive Targeting System Analytical or scientific software
 
StrataCare StrataWare eReview Expert system software
 
Tropics Claims Reserve Management Data base user interface and query software
 
atGlobal Allegro Document management software
 
atGlobal webMBR Expert system software
 
atGlobal webReports Document management software
 
Desktop computers Desktop computers
 
Notebook computers Notebook computers
 
Personal computers Personal computers
 
Personal digital assistants PDA Personal digital assistant PDAs or organizers
 
Scanners Scanners
 
Tablet computers Tablet computers
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
Prerequisite Qualification Category Education and Experience Level
Required Level of Education Bachelor's Degree
 
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
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
 
CompGeo Occupation Group: Insurance
Job Family: Insurance Claims
Benchmark Title: Claims Examiners, Property and Casualty Insurance
 
 
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