Claims Examiner Job Description

claims examiner job description includes a detailed overview of the key requirements, duties, responsibilities, and skills for this role.

Last update : July 14, 2023

Claims Examiner Job Description

Claims examiners are employees that examine insurance claims to determine if those claims are valid.

Claims examiners review the details of insurance claims to determine if the claim is correct.

They also may conduct field investigations, interview the claimant and witnesses, review medical records, and perform medical exams of the claimant, in addition to other duties.

Claims examiners are employed in both the public and private sectors.

Public sector claims examiners are employed by the United States Postal Service, the Department of the Interior, and the Internal Revenue Service.

Private sector claims examiners are employed primarily by insurance companies.

Job Brief:

We’re looking for a Claims Examiner to work in our insurance company. The job will involve reviewing insurance claims and determining whether they are valid. If you have experience in this field, please apply today.

Claims Examiner Duties:

  • Handle and manage insurance claims for both small and large clients
  • Develop risk scoring models, review, and rate claims
  • Work closely with clients and insurance companies
  • Update claim status reports
  • Retain up-to-date knowledge of benefits and coverages
  • Analyze and explain coverage options to clients
  • Assist customers with understanding their coverages
  • Communicate effectively with customers
  • Review and investigate claims
  • Act as a liaison between insurance companies and clients, answering questions, resolving claims issues, and facilitating claims settlements
  • Research, identify, and resolve claims issues
  • Implement claims systems
  • Investigate claims to determine appropriate resolution
  • Provide customers with accurate information about their claims
  • Manage claims and solve problems
  • Provide training to claims adjusters and service providers
  • Set positive example by exhibiting excellent communication skills, teamwork, and being punctual

Claims Examiner Responsibilities:

  • Track, investigate, and resolve workers’ compensation and liability claims
  • Monitor and communicate progress to supervisors, consultants, and attorneys, and assist with the coordination of claims
  • Implement and maintain company risk management policies
  • Perform other related duties as assigned

Requirements And Skills:

  • Bachelor’s degree in business, accounting, or a related field
  • 2+ years experience in credit/accounting, or loss prevention
  • Knowledge of metrics and reporting, and an ability to interpret data
  • Excellent analytical, problem-solving, and organizational skills

At [Company Name], we’re committed to creating an inclusive environment where everyone can thrive. We’re proud to be an equal opportunity employer, and we encourage applications from candidates of all backgrounds, experiences, and perspectives.

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