What does a Claims Examiner do?
Published 4 min read
A claims 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.
Claims Examiner job duties include:
- Examine claims submitted by policyholders to determine if coverage is provided under the terms of the insurance policy
- Investigate, evaluate and determine the extent of insurer’s liability in accordance with policy terms and conditions
- Calculate benefits payable on valid claims and process payments in a timely manner
- Deny claims or request additional information as needed when coverage is not provided or when fraud is suspected
- Maintain accurate records of all claim activity and correspondence
- Respond to inquiries from policyholders, claimants, agents and attorneys regarding status of claims and coverage issues
- Prepare reports on claim activity as requested by management
- Attend continuing education seminars to keep up-to-date on changes in the insurance industry and updates to claim processing procedures
- May supervise Claims Examiners or other support staff
Claims Examiner Job Requirements
A claims examiner is responsible for reviewing insurance claims and determining whether they are valid. They must have a strong understanding of the insurance policy in question, as well as any relevant laws and regulations. Claims examiners typically have a bachelor's degree in business administration or a related field. Some employers may also require certification from the American Institute for Property and Liability Underwriters. Claims examiners must have strong analytical and communication skills, as well as experience with claim processing software.
Claims Examiner Skills
- Analytical skills
- Communication skills
- Organizational skills
- Detail oriented
- Problem solving skills
- Research skills
- Writing skills
- Interpersonal skills
- Critical thinking skills
- Negotiation skills
- Time management skills
Related: Top Claims Examiner Skills: Definition and Examples
How to become a Claims Examiner
A Claims Examiner is a professional who reviews insurance claims to determine if they are valid and should be paid. To become a Claims Examiner, you will need to have a strong background in customer service, as you will be working with policyholders and claimants on a daily basis. You will also need to have excellent communication and organizational skills, as you will be reviewing large amounts of documentation on a regular basis. In addition, it is important to be detail-oriented and have the ability to multitask, as you will often be working on multiple claims at the same time.
If you possess these skills and qualities, then working as a Claims Examiner may be the right career choice for you. To get started, you will need to obtain a bachelor’s degree in business administration or a related field. Once you have your degree, you can then apply for positions with insurance companies or third-party claims administrators. Once you have been hired, you will receive training on the specific claim processes and procedures of your employer. With experience, you may eventually become a senior Claims Examiner or even a supervisor.
Related: Claims Examiner Resume Example
Related: Claims Examiner Interview Questions (With Example Answers)