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Insurance Claims Examiner Job Description – Claims examiners evaluate insurance claims and applications and follow up on the work of insurance adjusters to protect insurers from unnecessary financial loss, so perhaps you have been putting this position into consideration, this article will certainly clear your doubt on everything you need to know about this job position.
Who an Insurance Claims Examiner
Claims examiners review claims made against insurance companies. Examiners, who are sometimes called reviewers, are employed by life and health insurance companies. Claims examiners are responsible for approving or rejecting claims or arranging settlements. Unlike claims adjusters, who do much of their work at the scene of the loss or accident, claims examiners have desk jobs.
They do much of their work by telephone and by mail. When policyholders file claims, examiners check both the insurance policies and the claims to make sure that all the information is correct and to determine whether the claims are covered under the policies.
Insurance Claims Examiner Job Description
Insurance claims examiners are responsible for reviewing insurance claims which have been submitted to their company. These examiners generally work in office settings during traditional business hours, and little to no travel is required for the position.
A high school diploma is generally required, as well as additional courses and training regarding insurance claims and policies. Those in this position are employed in all types of insurance fields, and their responsibilities vary depending on the company.
Insurance claims examiners have a variety of responsibilities and duties, including evaluating insurance claims; following up with insurance adjusters; protecting customers and clients regarding unnecessary financial losses; reviewing filings and findings of insurance claims professionals; overseeing all documentation regarding insurance claims; reviewing large and complex cases which involve large financial payouts; reviewing questionable claims; settling cases or referring them for further investigation; making recommendations regarding claims; reviewing coverage applications; analyzing and verifying all data used to settle claims; obtaining various relevant records; and various administrative duties.
This position requires a person who is technologically adept and highly proficient with all forms of communication. Applicants should also have the expert critical thinking, decision-making, negotiating, and technical writing skills
Examiners also talk with policyholders, insurance agents, and other companies. Examiners may review medical bills or accident reports, or they may consult specialists. For example, an examiner might ask a doctor whether a claimed injury could have resulted from the type of accident that is being investigated.
When a claim has been carefully reviewed, the settlement is calculated and the claims examiner authorizes payment of the specified amount. Most claims examiners deal with cases in which the loss value is comparatively low. Large or unusual claims and possible false claims are referred to a senior examiner.
Claims examiners must keep careful records detailing the outcome of each step in the settlement process. They are often responsible for preparing summary reports. Some must testify in court, especially in cases where claims are being contested.
Claims examiners work for insurance companies, reviewing medical bills and accident reports to determine whether the policyholder’s claims are covered under their insurance policies.
Job Requirements of an Insurance Claim Examiner
Insurance claims examiners require a mix of analytic and people skills. To evaluate a health insurance claim, an examiner may have to consult with medical experts and study medical records. In life insurance, claims examiners may need to establish the cause of death, especially if the policy offers extra payment in case of death in an accident. In some cases, reaching a settlement with the claimant may require negotiation or even legal action, in which case the insurance claims examiner must work with lawyers on behalf of the insurance company.
Two years of college is usually the minimum requirement for employment as a junior claims examiner. Courses in law, business, math, and economics are helpful. Junior examiners are trained on the job by experienced workers.
Many companies prefer to hire applicants who have a bachelor’s degree. Insurance companies also like to employ examiners with some expertise in those areas that the company focuses on. For instance, a person with some medical training would have an advantage when applying for a job as a health insurance examiner. Many life and health claims examiners take company-sponsored courses to improve their skills. They may also take part in work-study programs offered by schools of insurance.
At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.
Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.
Insurance Claims Examiner Salary Information
An entry-level Insurance Claims Examiner with less than 1-year experience can expect to earn an average total compensation (includes tips, bonus, and overtime pay) of $42,856 based on 22 salaries. An early career Insurance Claims Examiner with 1-4 years of experience earns an average total compensation of $44,630 based on 60 salaries. A mid-career Insurance Claims Examiner with 5-9 years of experience earns an average total compensation of $60,013 based on 35 salaries.
An experienced Insurance Claims Examiner with 10-19 years of experience earns an average total compensation of $60,820 based on 33 salaries. In their late career (20 years and higher), employees earn an average total compensation of $82,523.
The median annual wage for claims adjusters, examiners, and investigators was $65,900 in May 2018. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $39,620, and the highest 10 percent earned more than $98,660.
The median annual wage for insurance appraisers, auto damage was $62,520 in May 2018. The lowest 10 percent earned less than $43,170, and the highest 10 percent earned more than $94,060.
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