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Claims Examiner Job Description

Summary

Responsible for reviewing claims after they are submitted to ensure proper guidelines and processes have been followed. Assists adjusters with complicated claims.

Primary responsibilities

  • Ensure proper guidelines were followed during claim phases.
  • Review claims to determine if costs were reasonable.
  • Check applications for completeness and accuracy.
  • Consult policy files to verify information reported in a claim.
  • Inspect property damage to determine extent of damages.
  • Evaluate damages to ascertain compensation amount.
  • Consult police and hospital records.
  • Consult with accountants, architects, construction workers, engineers, lawyers, and physicians to get expert evaluation.
  • Examine photographs and statements.
  • Listen to or watch audio or video surveillance.
  • Record data and statements in report.
  • Evaluate all information to determine how claim should be handled.
  • Negotiate with claimant to settle claim.
  • Work with attorneys to defend insurer's position is claim is contested.
  • Issue payout amounts.
  • Prepare and present claims to insurance companies.
  • Review new applications for life insurance to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

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