Claims Examiner

Claims Examiners are sometimes called "claims reviewers." Many claims examiners are employed by insurance companies although some work for government agencies. In general their job is to investigate and review a caseload of insurance claims. They verify all facts included in the claim make sure each claim is actually covered by the insurance policy and then determine how claims should be resolved.

The website says that claims examiners are responsible for completing claim reports that list all information about the claim and include details related to relevant medical records.

A claims examiner reviews all of the medical treatments a claimant gets and checks all medical bills to make sure the amount charged falls within accepted guidelines for the services and procedures listed. Based on this information they determine whether a claim should be paid or denied. It is best if claims examiners have a bachelor's degree but this is not a firm requirement.

The Department of Insurance in each state has its own licensing requirements for claims examiners. Newly-hired claims examiners usually get on-the-job training by working alongside experienced examiners. Claims examiners must keep abreast of changes in the law and in insurance industry policies by taking continuing education courses.

Claims examiners must be highly organized detail-oriented and capable of maintaining impeccable records – often for a number of different cases. They must have excellent oral and written communication skills because they must communicate with claimants and write reports that are easy to comprehend.

The website says that earnings for claims examiners depend on experience location employer and type of insurance handled. The median salary is approximately $34000.

Education Required: High School Diploma and Certificate/License
Avg Salary: $34000
High Salary: $38000
Low Salary: $30000
Tasks: Manages a case load of insurance claims.
Verifies insurance claims forms.
Denies or approves claims payments.
Keeps accurate records of each insurance claim.
Also Called: Claims Investigator
Claims Adjuster
Claims Reviewer
Insurance Examiner
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