Discover the essential requirements, duties, responsibilities, and skills needed for a Claims Examiner job description.
What does a Claims Examiner do?
A claims examiner is responsible for reviewing insurance claims and ensuring that proper procedures were followed during the investigation and reporting process. This includes reviewing reports from both the claimant and the claims adjuster, making decisions on whether to approve or deny a claim, and providing support to claims adjusters when needed.
Job Description
We are seeking candidates who are highly organized and have strong communication skills. The role of a claims examiner involves reviewing reports, making decisions on claims, and assisting claims adjusters during busy periods.
As a claims examiner, you will be responsible for overseeing the work of your colleagues and ensuring that all work is done to a high standard. This role requires confident decision-making and attention to detail.
Job Duties and Responsibilities
- Review reports to ensure accuracy in the appraisal process
- Determine the reasonableness of payouts
- Approve, reject, or refer a claim to a specialist
- Meet with claimants to resolve disputes
- Ensure compliance with regulations and company policies
- Provide support to claims adjusters during busy periods
- Consult with specialists such as lawyers, engineers, and physicians
- Assist in defending the company against any legal challenges
Requirements and Qualifications
- A high school diploma is required for entry-level positions
- A bachelor's degree in finance or a related field is preferred
- Strong administrative and organizational skills
- Attention to detail
- Excellent interpersonal skills
- Effective verbal and written communication
- Proficiency in math and spreadsheet software
- Demonstrated ability to make sound decisions
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