What do claims examiners do

Normally, a bachelor's degree is sufficient. There is also no formal certification process, but many larger insurance companies have in-house training programs. Previous experience in allied fields is often an important consideration in hiring. For example, insurance companies look to hire people with legal experience to be examiners for liability claims, those with medical experience to be examiners for health claims, and candidates with engineering or architectural backgrounds to be examiners for industrial claims.

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.

Insurance examiner positions in health insurance and life insurance offer good pay, regular hours, and stable working life. A large part of the job, though, involves turning down claims that are excessive or not covered by the policy. This negative aspect of the job, especially in health insurance, where the treatment of ill people is concerned, can be unappealing for some job seekers. Insurance claims examiners in life and health insurance tend to work a regular hour week from fixed office locations.

Those in property and casualty insurance generally have longer hours and more travel requirements, similar to insurance claims adjusters. Actively scan device characteristics for identification. It is their job to investigate it. It can also mean consulting with other professionals. In a medical claim, for instance, the claims examiner would consult a medical doctor to help analyze the merit of a claim.

When an insurance company wants to pursue a case against a policyholder, it does so after a recommendation by the claims examiner. In the litigation process, the legal counsel and the claim examiner work together on the case.

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Arm yourself with what you need to know to keep your assets and your family safe. By: Kaitlyn Kokoska. By: Steven Porrello. Estate Equalization. Insuranceopedia Terms. Insurance Tips for Newlyweds. 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. A policy is a contractual agreement between an insured person or business and an insurance company.

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.