Monday, October 9, 2017

Insurance Claims Examiners

Updated March 13, 2017

Among the career paths in insurance, insurance claims examiners do work similar to that of insurance claims adjusters. Examiner, rather than adjuster, is the usual title in life and health insurance. However, in property and casualty insurance, the title of examiner often designates a senior adjuster who handles the most costly or difficult claims. Other closely allied occupations are those of insurance appraisers and insurance investigators.

Education

Educational requirements vary greatly, depending on the position and the employer. Normally, a bachelor's degree is sufficient.

Certification

There are no formal certification processes, but many larger insurance companies have in-house training programs. However, previous experience in allied fields is often an important consideration in hiring. For example, insurance companies look to hire people with legal experience to be examiners for liability claims, people with medical experience to be examiners for health claims, people with engineering or architectural backgrounds to be examiners for industrial claims, etc.

Duties and Responsibilities

Insurance claims examiners require a mix of analytic and people skills. To evaluate a health insurance claim, an examiner may have to consult with medical experts and study medical records. In life insurance, claims examiners may need to establish the cause of death, especially if the policy offers extra payment in case of death in an accident.

In some cases, reaching a settlement with the claimant may require negotiation or even legal action, in which the insurance claims examiner must work with lawyers on behalf of the insurance company.

Typical Schedule

Insurance claims examiners in life and health insurance tend to work a regular 40 hour week from fixed office locations.

Those in property and casualty insurance will have longer hours and more travel requirements, similar to insurance claims adjusters.

What's to Like

Insurance examiner positions in health insurance and life insurance offer good pay, regular hours and a stable working life.

What's Not to Like

A large part of the job is turning down claims that are excessive or not covered by the policy. This negative aspect of the job, especially in health insurance, where the treatment of ill people is concerned, can be unattractive.