Claims Examiner Job Description
- 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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May. 21, 2012 QualCare Piscataway, NJ, US
QualCare, a successful Managed Care Organization, is currently seeking a Medical Claims Examiner. As a Medical Claims Examiner, yo...
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Apr. 07, 2012 Tufts Health Plan Watertown, MA, US
The Claims Examiner ensures member and provider satisfaction by providing appropriate and timely initial processing of claims. Cla...
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May. 10, 2012 Superior Technical Resources Northridge, CA, US
Superior Group has a contract position for a Claims Examiner III in their Northridge facility. POSITION SUMMARY Responsibl...
