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Medical and Health Services Managers

Medical and health services managers, also called healthcare executives or healthcare administrators, plan, direct, and coordinate medical and health services. They might manage an entire facility or specialize in managing a specific clinical area or department, or manage a medical practice for a group of physicians. As healthcare changes, medical and health services managers must be able to adapt to changes in laws, regulations, and technology.

Medical and health services managers typically do the following:

  • Work to improve efficiency and quality in delivering healthcare services
  • Keep up to date on new laws and regulations so the facility complies with them
  • Supervise assistant administrators in facilities that are large enough to need them
  • Manage finances of the facility, such as patient fees and billing
  • Create work schedules
  • Represent the facility at investor meetings or on governing boards
  • Keep and organize records of the facility's services, such as the number of inpatient beds used
  • Communicate with members of the medical staff and department heads

In group medical practices, managers work closely with physicians, nurses, laboratory technicians, and other healthcare employees. For more information, see the profiles on physicians and surgeons, registered nurses, and medical and clinical laboratory technologists and technicians.

Medical and health services managers' titles depend on the facility or area of expertise in which they work. The following are some examples of types of medical and health services managers:

Nursing home administrators manage staff, admissions, finances, and care of the building, as well as care of the residents in nursing homes. All states require them to be licensed; licensing requirements vary by state.

Clinical managers manage a specific department, such as nursing, surgery, or physical therapy and have responsibilities based on that specialty. Clinical managers set and carry out policies, goals, and procedures for their departments; evaluate the quality of the staff's work; and develop reports and budgets.

Health information managers are responsible for the maintenance and security of all patient records. They must stay up to date with evolving information technology and current or proposed laws about health information systems. Health information managers must ensure that databases are complete, accurate, and accessible only to authorized personnel.

Assistant administrators work under the top administrator in larger facilities and often handle daily decisions. Assistants might direct activities in clinical areas, such as nursing, surgery, therapy, medical records, or health information.


Fire Inspectors and Investigators

Fire inspectors visit and inspect buildings and other structures, such as sports arenas and shopping malls, to search for fire hazards and to ensure that federal, state, and local fire codes are met. They also test and inspect fire protection and fire extinguishing equipment to ensure that it works. Fire investigators determine the origin and cause of fires by searching the surrounding scene and collecting evidence.

Fire inspectors typically do the following:

  • Search for fire hazards
  • Ensure that buildings comply with fire codes
  • Test fire alarms, sprinklers, and other fire protection and extinguishing equipment
  • Inspect equipment such as gasoline storage tanks and air compressors
  • Review emergency evacuation plans
  • Conduct follow-up visits when an infraction is found
  • Confer with developers and planners to review plans for residential and commercial buildings
  • Conduct fire and life safety education programs
  • Keep detailed records that can be used in a court of law

Fire investigators typically do the following:

  • Collect and analyze evidence
  • Interview witnesses
  • Determine the origin and cause of a fire
  • Process and document evidence, such as photographs and diagrams
  • Reconstruct the scene of a fire or arson
  • Confer with other specialists, such as chemists, engineers, and attorneys, to analyze information
  • Send evidence to laboratories to be tested for fingerprints or an accelerant
  • Keep detailed records that can be used in a court of law
  • Testify in civil and criminal legal proceedings

Unlike fire inspectors, many fire investigators have police powers and carry a weapon.

Forest fire inspectors and prevention specialists assess fire hazards in both public and residential areas. They look for issues that pose a wildfire risk and recommend ways to reduce the fire hazard. During patrols, they ensure that the public is following fire regulations and report fire conditions to central command.


Cost Estimators

Cost estimators collect and analyze data to estimate the time, money, resources, and labor required for product manufacturing, construction projects, or services. Some specialize in a particular industry or product type.

Cost estimators typically do the following:

  • Consult with industry experts to discuss estimates and resolve issues
  • Identify and quantify cost factors, such as production time and raw material, equipment, and labor expenses
  • Travel to job sites to gather information on materials needed, labor requirements, and other factors 
  • Read blueprints and technical documents to prepare estimates
  • Collaborate with engineers, architects, owners, and contractors on estimates
  • Use sophisticated computer software to calculate estimates 
  • Evaluate a product's cost effectiveness or profitability
  • Recommend ways to make a product more cost effective or profitable
  • Prepare estimates for clients and other business managers
  • Develop project plans for the duration of the project

Accurately predicting the cost, size, and duration of future construction and manufacturing projects is vital to the survival of any business. Cost estimators' calculations give managers or investors this information.

When making calculations, estimators analyze many inputs to determine how much time, money, and labor a project needs, or how profitable it will be. These estimates have to take many factors into account, including allowances for wasted material, bad weather, shipping delays, and other factors that can increase costs and lower profitability.

Cost estimators use sophisticated computer software, including database, simulation, and complex mathematical programs. Cost estimators often use a computer database with information on the costs of other similar projects.

General contractors usually hire cost estimators for specific parts of a large construction project, such as estimating the electrical work or the excavation phase. In such cases, the estimator calculates the cost of the construction phase for which the contractor is responsible, rather than calculating the cost of the entire project. The general contractor usually also has a cost estimator who calculates the total project cost by analyzing the bids that the subcontractors' cost estimators prepared.

Some estimators are hired by manufacturers to analyze certain products or processes.

The following are the two primary types of cost estimators:

Construction cost estimators estimate construction work. More than half of all cost estimators work in the construction industry. They may, for example, estimate the total cost of building a bridge or a highway. They may identify direct costs, such as raw materials and labor requirements, and set a timeline for the project. Although many work directly for construction firms, some work for contractors, architects, and engineering firms.

Manufacturing cost estimators calculate the costs of developing, producing, or redesigning a company's goods and services. For example, a cost estimator working for a home appliance manufacturer may determine whether a new type of dishwasher will be profitable to manufacture.

Some manufacturing cost estimators work in software development. Many high-technology products require a considerable amount of computer programming, and the costs of software development are difficult to calculate.  

Two other groups also sometimes do cost estimating in their jobs. Operations research, production control, cost, and price analysts who work for government agencies may do significant amounts of cost estimating in the course of their usual duties. Construction managers also may spend considerable time estimating costs. For more information, see the profiles on operations research analysts and construction managers.


Claims Adjusters, Appraisers, Examiners, and Investigators

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much.

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants' doctors or employers to get additional information on questionable claims
  • Confer with legal counsel on claims when needed
  • Keep claims files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Negotiate settlements
  • Authorize payments

What insurance adjusters, examiners, and investigators do varies by the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable. 

Some claims adjusters work as self-employed public adjusters.

Often, they are hired by claimants who prefer not to rely on the insurance company's adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. The property they inspect could be a home, a business, or an automobile.

They interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. Adjusters may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

They gather information--including photographs and statements, either written or recorded audio or video--and put it in a report that claims examiners use to evaluate the claim. When the examiner approves policyholder's claim, the claims adjuster negotiates with the claimant and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer's position.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure that proper guidelines have been followed by claimants and adjusters. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from claimants overstating vehicle damage to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers' compensation claim, an investigator may covertly watch the claimant to see if he or she does activities that would be ruled out by injuries stated in the claim.


Accountants and Auditors

Accountants and auditors prepare and examine financial records. They ensure that financial records are accurate and that taxes are paid properly and on time. Accountants and auditors assess financial operations and work to help ensure that organizations run efficiently. 

Accountants and auditors typically do the following:

  • Examine financial statements to be sure that they are accurate and comply with laws and regulations
  • Compute taxes owed, prepare tax returns, and ensure that taxes are paid properly and on time
  • Inspect account books and accounting systems for efficiency and use of accepted accounting procedures
  • Organize and maintain financial records
  • Assess financial operations and make best-practices recommendations to management
  • Suggest ways to reduce costs, enhance revenues, and improve profits

In addition to examining and preparing financial documentation, accountants and auditors must explain their findings. This includes face-to-face meetings with organization managers and individual clients, and preparing written reports.

Many accountants and auditors specialize, depending on the particular organization that they work for. Some organizations specialize in assurance services (improving the quality or context of information for decision makers) or risk management (determining the probability of a misstatement on financial documentation). Other organizations specialize in specific industries, such as healthcare.

Some workers with a background in accounting and auditing teach in colleges and universities. For more information, see the profile on postsecondary teachers.

The four main types of accountants and auditors are the following:

Public accountants do a broad range of accounting, auditing, tax, and consulting tasks. Their clients include corporations, governments, and individuals.

They work with financial documents that clients are required by law to disclose. These include tax forms and balance sheet statements that corporations must provide potential investors. For example, some public accountants concentrate on tax matters, advising corporations about the tax advantages of certain business decisions or preparing individual income tax returns.

External auditors review clients' financial statements and inform investors and authorities that the statements have been correctly prepared and reported.

Public accountants, many of whom are Certified Public Accountants (CPAs), generally have their own businesses or work for public accounting firms.

Some public accountants specialize in forensic accounting, investigating financial crimes, such as securities fraud and embezzlement, bankruptcies and contract disputes, and other complex and possibly criminal financial transactions. Forensic accountants combine their knowledge of accounting and finance with law and investigative techniques to determine if an activity is illegal. Many forensic accountants work closely with law enforcement personnel and lawyers during investigations and often appear as expert witnesses during trials.

Management accountants, also called cost, managerial, industrial, corporate, or private accountants, record and analyze the financial information of the organizations for which they work. The information that management accountants prepare is intended for internal use by business managers, not by the general public.

They often work on budgeting and performance evaluation. They may also help organizations plan the cost of doing business. Some may work with financial managers on asset management, which involves planning and selecting financial investments such as stocks, bonds, and real estate.

Government accountants maintain and examine the records of government agencies and audit private businesses and individuals whose activities are subject to government regulations or taxation. Accountants employed by federal, state, and local governments ensure that revenues are received and spent in accordance with laws and regulations.

Internal auditors check for mismanagement of an organization's funds. They identify ways to improve the processes for finding and eliminating waste and fraud. The practice of internal auditing is not regulated, but the Institute of Internal Auditors (IIA) provides generally accepted standards.

Information technology auditors are internal auditors who review controls for their organization's computer systems, to ensure that the financial data comes from a reliable source.


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