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What does a Claim Examiner do?

Learn all about Claim Examiner duties, skills and much more. Get expert advice on how to become a Claim Examiner.

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Brenna Goyette
Certified Professional Resume Writer, Career Expert

Published 3 min read

A claim examiner is responsible for reviewing insurance claims and determining whether they are valid. The examiner will also determine how much the insurance company should pay out on the claim.

Claim Examiner job duties include:

  • Examine insurance claims to determine validity and extent of coverage
  • Investigate facts to determine liability of insurance company
  • Evaluate claim settlements to ensure fairness and compliance with policy terms
  • Prepare reports on findings
  • Recommend denial or approval of claims
  • Negotiate settlements with claimants
  • Authorize payment of claims
  • Maintain knowledge of updates in insurance law and coverage changes
  • Handle customer inquiries regarding claim status

Claim Examiner Job Requirements

Most claim examiner jobs require at least a bachelor’s degree in business, insurance, or a related field. Many employers also prefer candidates who have completed coursework in claims adjusting or have previous experience working in the insurance industry. Some states require claim examiners to be licensed as insurance producers or adjusters.

Claim Examiner Skills

  • Analytical skills
  • Communication skills
  • Organizational skills
  • Research skills
  • Writing skills
  • Critical thinking skills
  • Problem-solving skills
  • Attention to detail
  • Interpersonal skills
  • Flexibility
  • Time management

Related: Top Claim Examiner Skills: Definition and Examples

How to become a Claim Examiner

A Claim Examiner is responsible for investigating, evaluating and processing insurance claims. They work with policyholders, claimants, insurance companies and attorneys to ensure that claims are settled fairly and promptly.

To become a Claim Examiner, you will need at least a high school diploma. Many employers also requireClaim Examiners to have completed some college coursework, although it is not always necessary. Some Claim Examiners may also choose to pursue certification through organizations such as the American Institute for Property and Liability Underwriters (AIPLU) or the National Association of Insurance Adjusters (NAIA).

The best way to prepare for a career as a Claim Examiner is to complete an internship with an insurance company while you are still in school. This will give you the opportunity to learn about the claims process and develop the skills you need to be successful in this field.

Once you have graduated from college or completed your internship, you can begin applying for jobs as a Claim Examiner. Many insurance companies have entry-level positions available, so this is a great place to start your career. You can also look for job openings with independent adjusting firms or third-party administrators.

As you gain experience, you may eventually move into a management position or open your own adjusting firm. With hard work and dedication, you can build a successful career as a Claim Examiner.

Related: Claim Examiner Resume Example

Related: Claim Examiner Interview Questions (With Example Answers)