What duties and responsibilities does a Claims Examiner have?
1. Review and evaluate claim forms and supporting documents for completeness and accuracy. 2. Determine coverage eligibility and calculate payments according to policy terms and conditions. 3. Examine medical reports, bills, and other documents to determine the extent of the insurer’s liability. 4. Contact claimants, employers, medical providers, and other parties to obtain additional information and clarify claim details. 5. Investigate suspicious claims to detect and prevent fraud. 6. Negotiate settlements with claimants and other parties. 7. Monitor the progress of claims and ensure timely payments. 8. Maintain detailed records of claim activities. 9. Prepare and submit detailed reports to management. 10. Stay abreast of changes in the insurance industry and relevant laws and regulations.
Other Questions about Claims Examiner
- What is a Claims Examiner?
A Claims Examiner is a professional who evaluates insurance claims submitted by policyholders or claimants to determine whether the claim is valid and should be paid. They may also review medical records, investigate the cause of an accident, or evaluate the extent of the damage to determine the amount of compensation to be paid. Claims Examiners typically work for insurance companies or self-insured employers.
- What qualifications are required for a Claims Examiner?
A Claims Examiner typically needs to have a minimum of a high school diploma or GED. Additional qualifications may include an Associate degree in a business-related field, insurance-related field, or a related field. Experience in insurance adjusting, claims handling, and customer service is also beneficial. Claims Examiners should also have knowledge of various state and federal regulations, as well as excellent problem-solving and communication skills.
- What type of education is required for a Claims Examiner?
Most employers require a Claims Examiner to have a minimum of a bachelor's degree in business, finance, accounting, or a related field. Claims Examiners may also be required to have a professional certification such as an Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU).
- What is the job outlook for Claims Examiners?
The job outlook for Claims Examiners is projected to grow by 7% from 2019 to 2029, which is faster than the average for all occupations. The demand for Claims Examiners is expected to increase as insurance companies become more complex and the number of claims filed rises. Claims Examiners will also be needed to review and analyze complex claims, ensure claims are accurate and up-to-date, and work with claimants to resolve any disputes.
- What type of salary can a Claims Examiner expect?
A Claims Examiner typically makes an annual salary ranging from $45,000 to $65,000. Some experienced Claims Examiners may make more than this amount. Salaries may vary based on experience, location, and other factors.