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Claims Examiners, Property & Casualty Insurance
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CheckoutCareers.com
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Claims Examiners, Property & Casualty Insurance
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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.
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Degrees
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Abilities
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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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Deductive Reasoning| | The ability to apply general rules to specific problems to produce answers that make sense. |
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Oral Expression| | The ability to communicate information and ideas in speaking so others will understand. |
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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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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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Speech Recognition| | The ability to identify and understand the speech of another person. |
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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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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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Category Flexibility| | The ability to generate or use different sets of rules for combining or grouping things in different ways. |
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Speech Clarity| | The ability to speak clearly so others can understand you. |
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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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Number Facility| | The ability to add, subtract, multiply, or divide quickly and correctly. |
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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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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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Mathematical Reasoning| | The ability to choose the right mathematical methods or formulas to solve a problem. |
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Far Vision| | The ability to see details at a distance. |
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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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Speed of Closure| | The ability to quickly make sense of, combine, and organize information into meaningful patterns. |
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Memorization| | The ability to remember information such as words, numbers, pictures, and procedures. |
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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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Finger Dexterity| | The ability to make precisely coordinated movements of the fingers of one or both hands to grasp, manipulate, or assemble very small objects. |
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Visualization| | The ability to imagine how something will look after it is moved around or when its parts are moved or rearranged. |
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Auditory Attention| | The ability to focus on a single source of sound in the presence of other distracting sounds. |
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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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Hearing Sensitivity| | The ability to detect or tell the differences between sounds that vary in pitch and loudness. |
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Visual Color Discrimination| | The ability to match or detect differences between colors, including shades of color and brightness. |
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Arm-Hand Steadiness| | The ability to keep your hand and arm steady while moving your arm or while holding your arm and hand in one position. |
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Control Precision| | The ability to quickly and repeatedly adjust the controls of a machine or a vehicle to exact positions. |
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Manual Dexterity| | The ability to quickly move your hand, your hand together with your arm, or your two hands to grasp, manipulate, or assemble objects. |
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Depth Perception| | The ability to judge which of several objects is closer or farther away from you, or to judge the distance between you and an object. |
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Wrist-Finger Speed| | The ability to make fast, simple, repeated movements of the fingers, hands, and wrists. |
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Interests
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Conventional| | Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow. |
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First Interest High-Point| | Primary-Rank Descriptiveness |
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Second Interest High-Point| | Secondary-Cutoff/Rank Descriptiveness |
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Enterprising| | Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business. |
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Social| | Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others. |
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Investigative| | Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally. |
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Artistic| | Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules. |
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Realistic| | Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others. |
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Knowledge
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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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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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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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Computers and Electronics| | Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming. |
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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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Education and Training| | Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects. |
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Mathematics| | Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications. |
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Medicine and Dentistry| | Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures. |
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Psychology| | Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders. |
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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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Public Safety and Security| | Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions. |
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Personnel and Human Resources| | Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems. |
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Communications and Media| | Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media. |
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Therapy and Counseling| | Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance. |
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Economics and Accounting| | Knowledge of economic and accounting principles and practices, the financial markets, banking and the analysis and reporting of financial data. |
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Sales and Marketing| | Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems. |
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Transportation| | Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including the relative costs and benefits. |
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Geography| | Knowledge of principles and methods for describing the features of land, sea, and air masses, including their physical characteristics, locations, interrelationships, and distribution of plant, animal, and human life. |
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Telecommunications| | Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems. |
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Production and Processing| | Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods. |
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Sociology and Anthropology| | Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures and their history and origins. |
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Mechanical| | Knowledge of machines and tools, including their designs, uses, repair, and maintenance. |
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Building and Construction| | Knowledge of materials, methods, and the tools involved in the construction or repair of houses, buildings, or other structures such as highways and roads. |
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Philosophy and Theology| | Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture. |
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History and Archeology| | Knowledge of historical events and their causes, indicators, and effects on civilizations and cultures. |
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Foreign Language| | Knowledge of the structure and content of a foreign (non-English) language including the meaning and spelling of words, rules of composition and grammar, and pronunciation. |
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Chemistry| | Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods. |
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Biology| | Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment. |
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Engineering and Technology| | Knowledge of the practical application of engineering science and technology. This includes applying principles, techniques, procedures, and equipment to the design and production of various goods and services. |
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Physics| | Knowledge and prediction of physical principles, laws, their interrelationships, and applications to understanding fluid, material, and atmospheric dynamics, and mechanical, electrical, atomic and sub- atomic structures and processes. |
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Design| | Knowledge of design techniques, tools, and principles involved in production of precision technical plans, blueprints, drawings, and models. |
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Food Production| | Knowledge of techniques and equipment for planting, growing, and harvesting food products (both plant and animal) for consumption, including storage/handling techniques. |
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Fine Arts| | Knowledge of the theory and techniques required to compose, produce, and perform works of music, dance, visual arts, drama, and sculpture. |
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Wages
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| District of Columbia | $44,330.00 |
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| North Carolina | $43,060.00 |
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| Virgin Islands | $31,410.00 |
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Related Careers
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Cost Estimators| | Prepare cost estimates for product manufacturing, construction projects, or services to aid management in bidding on or determining price of product or service. May specialize according to particular service performed or type of product manufactured. |
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Credit Checkers| | Investigate history and credit standing of individuals or business establishments applying for credit. Telephone or write to credit departments of business and service establishments to obtain information about applicant's credit standing. |
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Insurance Appraisers, Auto Damage| | Appraise automobile or other vehicle damage to determine cost of repair for insurance claim settlement and seek agreement with automotive repair shop on cost of repair. Prepare insurance forms to indicate repair cost or cost estimates and recommendations. |
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Insurance Policy Processing Clerks| | Process applications for, changes to, reinstatement of, and cancellation of insurance policies. Duties include reviewing insurance applications to ensure that all questions have been answered, compiling data on insurance policy changes, changing policy records to conform to insured party's specifications, compiling data on lapsed insurance policies to determine automatic reinstatement according to company policies, canceling insurance policies as requested by agents, and verifying the accuracy of insurance company records. |
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Insurance Underwriters| | Review individual applications for insurance to evaluate degree of risk involved and determine acceptance of applications. |
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Title Examiners, Abstractors, & Searchers| | Search real estate records, examine titles, or summarize pertinent legal or insurance details for a variety of purposes. May compile lists of mortgages, contracts, and other instruments pertaining to titles by searching public and private records for law firms, real estate agencies, or title insurance companies. |
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Skills
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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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Reading Comprehension| | Understanding written sentences and paragraphs in work related documents. |
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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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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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Instructing| | Teaching others how to do something. |
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Speaking| | Talking to others to convey information effectively. |
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Time Management| | Managing one's own time and the time of others. |
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Persuasion| | Persuading others to change their minds or behavior. |
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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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Social Perceptiveness| | Being aware of others' reactions and understanding why they react as they do. |
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Learning Strategies| | Selecting and using training/instructional methods and procedures appropriate for the situation when learning or teaching new things. |
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Mathematics| | Using mathematics to solve problems. |
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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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Complex Problem Solving| | Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. |
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Coordination| | Adjusting actions in relation to others' actions. |
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Negotiation| | Bringing others together and trying to reconcile differences. |
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Service Orientation| | Actively looking for ways to help people. |
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Quality Control Analysis| | Conducting tests and inspections of products, services, or processes to evaluate quality or performance. |
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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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Management of Financial Resources| | Determining how money will be spent to get the work done, and accounting for these expenditures. |
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Systems Evaluation| | Identifying measures or indicators of system performance and the actions needed to improve or correct performance, relative to the goals of the system. |
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Science| | Using scientific rules and methods to solve problems. |
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Management of Material Resources| | Obtaining and seeing to the appropriate use of equipment, facilities, and materials needed to do certain work. |
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Operations Analysis| | Analyzing needs and product requirements to create a design. |
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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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Operation and Control| | Controlling operations of equipment or systems. |
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Troubleshooting| | Determining causes of operating errors and deciding what to do about it. |
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Technology Design| | Generating or adapting equipment and technology to serve user needs. |
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Equipment Selection| | Determining the kind of tools and equipment needed to do a job. |
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Equipment Maintenance| | Performing routine maintenance on equipment and determining when and what kind of maintenance is needed. |
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Installation| | Installing equipment, machines, wiring, or programs to meet specifications. |
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Operation Monitoring| | Watching gauges, dials, or other indicators to make sure a machine is working properly. |
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Programming| | Writing computer programs for various purposes. |
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Repairing| | Repairing machines or systems using the needed tools. |
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Tasks
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| 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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| Supervise claims adjusters to ensure that adjusters have followed proper methods. |
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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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| Conduct detailed bill reviews to implement sound litigation management and expense control. |
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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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| Prepare reports to be submitted to company's data processing department. |
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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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Tools
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| Desktop computers |
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| Notebook computers |
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| Personal computers |
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| Personal digital assistant PDAs or organizers |
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| Personal digital assistant PDAs |
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| Scanners |
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| Tablet computers |
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Technology
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| Access software |
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| CCC EZNet electronic communications network |
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| CSC Automated Work Distributor AWD |
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| Analytical or scientific software |
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| Insurance claims fraud detection software |
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| Magnify Predictive Targeting System |
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| Data base reporting software |
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| Corporate Systems ClaimsPro |
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| Data base user interface and query software |
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| Claims processing administration and management software |
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| Fair Isaac Claims Advisor |
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| Tropics Claims Reserve Management |
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| Document management software |
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| Agency Management Systems AMS 360 |
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| atGlobal Allegro |
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| atGlobal webReports |
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| AutoClaims Direct DirectLink |
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| Automatic Data Processing Autosource |
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| Automatic Data Processing Claims Manager & Dispatch |
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| BCCORP W5 for Adjusters |
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| Bramerhill ClaimsTech |
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| Bridium Claims 3 |
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| Brightwork Alyce Claims Systems |
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| Captiva InputAccel |
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| Castek Insure3 Claims |
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| CCC Pathways Image Management Solution |
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| CCC TL2000 Solution |
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| CGI INSideOUT |
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| Clear Technology Tranzax |
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| Covansys ClaimConnect |
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| Datanex ClaimTrac |
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| Hyland OnBase Enterprise Content Management |
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| InSystems Calligo Document Management System |
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| Enterprise resource planning ERP software |
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| CCC Pathways Appraisal Quality Solution |
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| Expert system software |
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| atGlobal webMBR |
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| Axonwave Fraud and Abuse Management System |
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| Bill review software |
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| CCC GuidePost Decision Support |
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| CSC Fault Evaluator |
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| Fair Isaac SmartAdvisor |
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| First Notice Systems ClaimCapture |
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| Hummingbird Legal Bill Review |
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| IBM Fraud and Abuse Management System |
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| ISO ClaimSearch |
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| ISO NetMap for Claims |
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| LexisNexis RiskWise |
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| StrataCare StrataWare eReview |
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| Interactive voice response software |
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| Computerized voice stress analyzer CVSA software |
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Career Activities
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| Communicating with Persons Outside Organization |
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| communicate technical information |
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| compile information through interviews |
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| confer with prosecuting attorney |
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| make presentations |
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| Getting Information |
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| obtain information from individuals |
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| Documenting/Recording Information |
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| maintain insurance records |
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| Processing Information |
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| investigate insurance claims |
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| note discrepancies in financial records |
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| verify investigative information |
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| Evaluating Information to Determine Compliance with Standards |
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| examine documents for completeness, accuracy, or conformance to standards |
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| review data on insurance applications or policies |
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| Performing Administrative Activities |
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| maintain records, reports, or files |
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| prepare reports |
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| Updating and Using Relevant Knowledge |
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| follow contract, property, or insurance laws |
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| use interviewing procedures |
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| use knowledge of investigation techniques |
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| Interacting With Computers |
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| use computers to enter, access or retrieve data |
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| Provide Consultation and Advice to Others |
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| recommend claim action |
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| Coordinating the Work and Activities of Others |
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| direct and coordinate activities of workers or staff |
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| Monitoring and Controlling Resources |
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| develop management control systems |
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Career Context
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| Indoors, Environmentally Controlled |
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| Spend Time Sitting |
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| Electronic Mail |
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| Telephone |
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| Freedom to Make Decisions |
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| Letters and Memos |
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| Frequency of Decision Making |
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| Structured versus Unstructured Work |
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| Face-to-Face Discussions |
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| Importance of Repeating Same Tasks |
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| Contact With Others |
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| Importance of Being Exact or Accurate |
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| Impact of Decisions on Co-workers or Company Results |
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| Deal With External Customers |
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| Responsibility for Outcomes and Results |
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| Work With Work Group or Team |
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| Coordinate or Lead Others |
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| Spend Time Using Your Hands to Handle, Control, or Feel Objects, Tools, or Controls |
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| Time Pressure |
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| Deal With Unpleasant or Angry People |
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| Sounds, Noise Levels Are Distracting or Uncomfortable |
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| Spend Time Making Repetitive Motions |
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| Frequency of Conflict Situations |
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| In an Enclosed Vehicle or Equipment |
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| Outdoors, Exposed to Weather |
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| Indoors, Not Environmentally Controlled |
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| Very Hot or Cold Temperatures |
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| Level of Competition |
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| Exposed to Radiation |
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| Extremely Bright or Inadequate Lighting |
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| Pace Determined by Speed of Equipment |
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| Consequence of Error |
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| Cramped Work Space, Awkward Positions |
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| Degree of Automation |
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Career Styles
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Dependability| | Job requires being reliable, responsible, and dependable, and fulfilling obligations. |
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Attention to Detail| | Job requires being careful about detail and thorough in completing work tasks. |
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Integrity| | Job requires being honest and ethical. |
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Adaptability/Flexibility| | Job requires being open to change (positive or negative) and to considerable variety in the workplace. |
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Analytical Thinking| | Job requires analyzing information and using logic to address work-related issues and problems. |
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Cooperation| | Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude. |
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Stress Tolerance| | Job requires accepting criticism and dealing calmly and effectively with high stress situations. |
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Initiative| | Job requires a willingness to take on responsibilities and challenges. |
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Self Control| | Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations. |
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Persistence| | Job requires persistence in the face of obstacles. |
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Independence| | Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done. |
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Achievement/Effort| | Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks. |
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Concern for Others| | Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job. |
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Leadership| | Job requires a willingness to lead, take charge, and offer opinions and direction. |
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Innovation| | Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems. |
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Social Orientation| | Job requires preferring to work with others rather than alone, and being personally connected with others on the job. |
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Career Needs
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Company Policies and Practices| | Workers on this job are treated fairly by the company. |
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Supervision, Human Relations| | Workers on this job have supervisors who back up their workers with management. |
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Working Conditions| | Workers on this job have good working conditions. |
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Advancement| | Workers on this job have opportunities for advancement. |
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Security| | Workers on this job have steady employment. |
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Responsibility| | Workers on this job make decisions on their own. |
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Independence| | Workers on this job do their work alone. |
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Activity| | Workers on this job are busy all the time. |
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Autonomy| | Workers on this job plan their work with little supervision. |
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Moral Values| | Workers on this job are never pressured to do things that go against their sense of right and wrong. |
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Compensation| | Workers on this job are paid well in comparison with other workers. |
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| Supervision, Technical | | | | |
