What does a Claims Examiner do?

Claims examiners review insurance claims to verify both the claimant and claim adjuster followed due process during the investigation and reporting phase of a case. Claims examiners ensure legal compliance and approve or deny insurance claims while assisting adjusters when needed. They diligently review reports to ensure that no errors have been made in the appraisal process and determine whether payout amounts are reasonable. They approve, reject, or refer a claim to a specialist and meet with claimants with dispute settlements.

Claims examiners ensure cases comply with regulatory standards, company policy, and guidelines and provide assistance to claim adjusters to manage caseloads. Claims examiners consult with specialists including lawyers or engineers and assist attorneys and other specialists when defending the company against contested claims. They contribute to the final decision coverage of losses due to an accident or illness. Claims examiners need a high school diploma for an entry-level position, and a bachelor's degree in finance or related fields is preferred.

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Average Years of Experience

0 - 1
2 - 4
5 - 7

Common Skill Sets

Microsoft Office Suite
Written Communication
Excellent Organizational
Interpersonal and Communication
Critical Thinking
Associate Degree Required
CPT Coding

Claims Examiner Seniority Levels

Claims Analyst
9% made the transition
Claims Adjuster
31% made the transition
See Career Path

Claims Examiner Salaries

Glassdoor Estimated Salary

Claims Examiner Jobs