Claims Examiner

Education and Training: Two- or four-year college

Salary: Median—$33,669 per year

Employment Outlook: Good

Definition and Nature of the Work

Claims examiners review claims made against insurance companies. Examiners, who are sometimes called reviewers, are employed by life and health insurance companies. Claims examiners are responsible for approving or rejecting claims or arranging settlements.

Unlike claims adjusters, who do much of their work at the scene of the loss or accident, claims examiners have desk jobs. They do much of their work by telephone and by mail. When policyholders file claims, examiners check both the insurance policies and the claims to make sure that all the information is correct and to determine whether the claims are covered under the policies. (A policy is a contractual agreement between an insured person or business and an insurance company.) Examiners also talk with policyholders, insurance agents, and other companies. Examiners may review medical bills or accident reports, or they may consult specialists. For example, an examiner might ask a doctor whether a claimed injury could have resulted from the type of accident that is being investigated.

When a claim has been carefully reviewed, the settlement is calculated and the claims examiner authorizes payment of the specified amount. Most claims examiners deal with cases in which the loss value is comparatively low. Large or unusual claims and possible false claims are referred to a senior examiner.

Claims examiners must keep careful records detailing the outcome of each step in the settlement process. They are often responsible for preparing summary reports. Some must testify in court, especially in cases where claims are being contested.

Education and Training Requirements

Two years of college is usually the minimum requirement for employment as a junior claims examiner. Courses in law, business, math, and economics are helpful. Junior examiners are trained on the job by experienced workers.

Many companies prefer to hire applicants who have a bachelor's degree. Insurance companies also like to employ examiners with some expertise in those areas that the company focuses on. For instance, a person with some medical training would have an advantage when applying for a job as a health insurance examiner. Many life and health claims examiners take company-sponsored courses to improve their skills. They may also take part in work–study programs offered by schools of insurance.

Getting the Job

Interested individuals can contact insurance companies directly for jobs. State and local insurance associations may offer suggestions about the best places to apply and the appropriate people to see when applying. Openings for claims examiners are often advertised in newspapers and on the Internet.

Advancement Possibilities and Employment Outlook

Claims examiners may become senior claims representatives, supervisors, underwriters, or administrators. Those with college training have the best chance for advancement.

According to the U.S. Bureau of Labor Statistics, claims examiner employment was expected to grow as fast as the average for all occupations through the year 2014. Many openings will occur as experienced workers retire or leave their jobs for other reasons. Although computers have taken over some of the routine tasks that were done by examiners in the past, the demand for skilled claims examiners will keep pace with the rest of the economy. Jobs in the health-care insurance industry should increase the most. As the American population ages, the number of health insurance claims and life insurance policies are expected to balloon.

Working Conditions

Claims examiners normally work from thirty-five to forty hours per week in pleasant offices. Their work involves thorough investigation of insurance claims. When quarterly or yearly statements are prepared, examiners may work overtime.

Earnings and Benefits

Salaries vary depending on experience, location of the work, and the type of insurance involved. The median annual salary for claims examiners was $33,669 in 2006, according to salary.com.

Where to Go for More Information

American Council of Life Insurance
1001 Constitution Ave. NW
Washington, DC 20001-2133
(202) 624-2000
http://www.acli.com

American Institute for Chartered Property Casualty Underwriters and the Insurance Institute of America
720 Providence Rd.
PO Box 3016
Malvern, PA 19355
(800) 644-2101
http://www.aicpcu.org

Insurance Information Institute
110 William St.
New York, NY 10038
(212) 346-5500
http://www.iii.org

International Claim Association
1 Thomas Circle NW, 10th Fl.
Washington, DC 20005
(202) 452-0143
http://www.claim.org

Property Casualty Insurers Association of North America
2600 S. River Rd.
Des Plaines, IL 60018
(847) 297-7800
http://www.pciaa.net

The benefits offered by insurance companies are usually good. Examiners generally receive health and life insurance in addition to paid vacations and holidays. Many companies reimburse examiners for job-related educational expenses.