Claims Examiners review insurance claims to verify that due process was followed in the investigation and reporting of claims by both Claims Adjusters and claimants. Claims Examiners ensure legal compliance, approve or deny insurance claims and provide assistance to Claims Adjusters when needed.
Claims Examiner Job Description Template
We are looking for highly organized, diligent candidates with good interpersonal and communication skills. Claims Examiners are required to review reports by claimants and Claims Adjusters, approve or reject a claim and assist Claims Adjusters in times of high case volume.
Claims Examiners are confident decision-makers playing an important oversight role in the claims process. The role comes with the responsibility of overseeing the work of their colleagues and ensuring that high standards are always met.
Claims Examiner Responsibilities:
- Diligently review reports to ensure that no errors have been made in the appraisal process.
- Determine whether payouts are reasonable.
- Approve, reject or refer a claim to a specialist.
- Meet with claimants and settle disputes.
- Ensure compliance with regulatory standards, company policy and guidelines.
- Provide assistance to Claims Adjusters to manage the volume of cases.
- Consult with specialists such as lawyers, engineers, architects and physicians.
- Assist attorneys and other specialists when defending the company against contestation.
Claims Examiner Requirements:
- High school diploma for entry level jobs.
- Bachelor's degree in finance or related field preferred.
- Sound administrative and organizational skills.
- Great attention to detail.
- Good interpersonal skills.
- Excellent verbal and written communication.
- Proficiency with mathematics and spreadsheet software.
- Demonstrated decision-making ability.