Claims Examiners, Property and Casualty Insurance

Description

Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

Tasks

  • Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Pay and process claims within designated authority level.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Confer with legal counsel on claims requiring litigation.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Present cases and participate in their discussion at claim committee meetings.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Report overpayments, underpayments, and other irregularities.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.

Knowledge

Biology
Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.

Skills

Operation and Control
Controlling operations of equipment or systems.
Operations Analysis
Analyzing needs and product requirements to create a design.
Science
Using scientific rules and methods to solve problems.
Equipment Selection
Determining the kind of tools and equipment needed to do a job.
Installation
Installing equipment, machines, wiring, or programs to meet specifications.
Equipment Maintenance
Performing routine maintenance on equipment and determining when and what kind of maintenance is needed.
Repairing
Repairing machines or systems using the needed tools.

Abilities

Trunk Strength
The ability to use your abdominal and lower back muscles to support part of the body repeatedly or continuously over time without 'giving out' or fatiguing.
Spatial Orientation
The ability to know your location in relation to the environment or to know where other objects are in relation to you.
Response Orientation
The ability to choose quickly between two or more movements in response to two or more different signals (lights, sounds, pictures). It includes the speed with which the correct response is started with the hand, foot, or other body part.
Rate Control
The ability to time your movements or the movement of a piece of equipment in anticipation of changes in the speed and/or direction of a moving object or scene.
Reaction Time
The ability to quickly respond (with the hand, finger, or foot) to a signal (sound, light, picture) when it appears.
Sound Localization
The ability to tell the direction from which a sound originated.
Speed of Limb Movement
The ability to quickly move the arms and legs.
Static Strength
The ability to exert maximum muscle force to lift, push, pull, or carry objects.
Explosive Strength
The ability to use short bursts of muscle force to propel oneself (as in jumping or sprinting), or to throw an object.
Dynamic Strength
The ability to exert muscle force repeatedly or continuously over time. This involves muscular endurance and resistance to muscle fatigue.

Work Activities

Operating Vehicles, Mechanized Devices, or Equipment
Running, maneuvering, navigating, or driving vehicles or mechanized equipment, such as forklifts, passenger vehicles, aircraft, or water craft.
Repairing and Maintaining Mechanical Equipment
Servicing, repairing, adjusting, and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical (not electronic) principles.

Interests

Conventional
Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
Enterprising
Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
Investigative
Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Realistic
Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Social
Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Artistic
Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.

Work Style

Integrity
Job requires being honest and ethical.
Dependability
Job requires being reliable, responsible, and dependable, and fulfilling obligations.
Attention to Detail
Job requires being careful about detail and thorough in completing work tasks.
Stress Tolerance
Job requires accepting criticism and dealing calmly and effectively with high stress situations.
Self Control
Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
Cooperation
Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
Independence
Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
Persistence
Job requires persistence in the face of obstacles.
Analytical Thinking
Job requires analyzing information and using logic to address work-related issues and problems.
Adaptability/Flexibility
Job requires being open to change (positive or negative) and to considerable variety in the workplace.

Work Values

Support
Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
Independence
Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
Working Conditions
Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
Relationships
Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
Achievement
Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
Recognition
Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.

Lay Titles

Case Manager
Check Examiner
Claim Auditor
Claims Account Manager
Claims Account Specialist
Claims Adjuster
Claims Analyst
Claims Auditor
Claims Director
Claims Examiner
Claims Manager
Claims Representative
Claims Specialist
Claims Supervisor
Claims Vice President
Customer Care Specialist
Home Office Claim Specialist
Insurance Auditor
Insurance Examiner
Liability Claims Manager
Liability Claims Representative
Litigation Examiner
Property Damage Claims Adjustor
Reinsurance Claim Analyst
Workers Compensation Claims Examiner
Workers Compensation Examiner

National Wages and Employment Info

Median Wages (2008):
$28.83 hourly, $59,960 annual.
Employment (2008):
263,280 employees