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What are the Different Claims Examiner Jobs?

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  • Written By: Jessica Bosari
  • Edited By: Bronwyn Harris
  • Last Modified Date: 05 November 2016
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Insurance claims examiner jobs exist in several types of insurance companies such as property and casualty, life, medical and workers compensation. Claims examiner jobs in the property and casualty sector are similar to those of claims adjusters, but claims examiner work on large and complicated claims. Medical claims examiner jobs are similar to medical billing specialist jobs and life insurance examiners do a mix of underwriting and claims-related work.

No matter the type of insurance, the claims examiner’s job involves a few basic functions. These include carefully reviewing cases, checking for proper claims handling, gathering facts and authorizing payment when appropriate. The job requires great attention to detail, along with an understanding of medical terminology and medical coding.

The insurance claims examiner job description involves reviewing large or complex claims that the claims adjuster is unable to resolve. The claims examiner is co-assigned to the case as an extra set of eyes to monitor and direct the claim. The claims examiner will check on the case at regular intervals and review the claim to be certain the case handling follows proper guidelines.

Claim examiner’s jobs also involve careful recordkeeping. The examiner must detail all conversations and transactions to be certain all facts about the claim are considered in the handling of the case. Many claim examiners must file periodic detailed reports regarding the status of a claim for review by claims managers.

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Claims examiner jobs at medical and health insurance companies involve medical coding. The examiners review claims to ensure charges are reasonable, based on the medical diagnosis and approved medical procedures. Medical claims examiners also ensure that the hospital stay is reasonable for the diagnosis and treatment the patient receives.

Workers compensation insurance examiners work to ensure claimants are properly paid, referencing the injury diagnosis and the expected length of disability for such an injury. They will calculate the correct disability and lost wage payments to workers and work with medical providers to ensure billing is accurate and fair. They will also order independent medical examinations and ensure the injured worker completes all claim paperwork properly.

Life insurance claims examiner jobs include claims functions and some underwriting related functions. These examiners will review applications and investigate to verify there are no serious illnesses that might make an applicant a high risk. The claims examiner will also review sensitive information such as the cause of death and may need to interview family members.

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