Property and Casualty Insurance Claims Examiners

Finance > Insurance

Projected Growth: Decline

25800+
Projected Job Openings

Considerable Preparation Needed

Job Description

Your job is to 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.

Common job titles of Property and Casualty Insurance Claims Examiners include:
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Experience and Education

A considerable amount of work-related skill, knowledge, or experience is needed for this occupation. For example, a person in this occupation must complete four years of college and work for several years in industry to be considered qualified.

  • 69.21% said they needed a Bachelor's Degree.

  • 11.58% said they needed a High School Diploma.

Essential 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.

    Confer with legal counsel on claims requiring litigation.

    Resolve complex, severe exposure claims, using high service oriented file handling.

    Pay and process claims within designated authority level.

    Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

    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.

    Contact or interview claimants, doctors, medical specialists, or employers to get additional information.

    Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

    Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.

    Conduct detailed bill reviews to implement sound litigation management and expense control.

    Supervise claims adjusters to ensure that adjusters have followed proper methods.


Regular Tasks

    Prepare reports to be submitted to company's data processing department.

    Present cases and participate in their discussion at claim committee meetings.


Occasional Tasks

    Communicate with reinsurance brokers to obtain information necessary for processing claims.

    Report overpayments, underpayments, and other irregularities.

Tools

Tablet computers

Scanners

Personal digital assistants PDA

Personal computers

Notebook computers

Desktop computers

Technologies

CCC Pathways Appraisal Quality Solution

Agency Management Systems AMS 360

AutoClaims Direct DirectLink

Automatic Data Processing Autosource

Automatic Data Processing Claims Manager & Dispatch

Axonwave Fraud and Abuse Management System

BCCORP W5 for Adjusters

All Technologies

Bill review software

Bramerhill ClaimsTech

Bridium Claims 3

Brightwork Alyce Claims Systems

Captiva InputAccel

Castek Insure3 Claims

CCC EZNet electronic communications network

CCC GuidePost Decision Support

CCC Pathways Image Management Solution

CCC TL2000 Solution

CGI INSideOUT

Claims processing administration and management software

Clear Technology Tranzax

Computerized voice stress analyzer CVSA software

Corporate Systems ClaimsPro

Covansys ClaimConnect

CSC Automated Work Distributor AWD

CSC Fault Evaluator

Datanex ClaimTrac

Document management system software

Fair Isaac Claims Advisor

Fair Isaac SmartAdvisor

First Notice Systems ClaimCapture

Hummingbird Legal Bill Review

Hyland OnBase Enterprise Content Management

IBM Fraud and Abuse Management System

Insurance claims fraud detection software

InSystems Calligo Document Management System

ISO ClaimSearch

ISO NetMap for Claims

LexisNexis RiskWise

Magnify Predictive Targeting System

Medical procedure coding software

StrataCare StrataWare eReview

Tropics Claims Reserve Management

Abilities

Cognitive Abilities › Verbal Abilities › Oral Comprehension

Listen to and understand information and ideas presented through spoken words and sentences.

Cognitive Abilities › Verbal Abilities › Written Comprehension

Read and understand information and ideas presented in writing.

Cognitive Abilities › Verbal Abilities › Oral Expression

Communicate information and ideas in speaking so others will understand.

Cognitive Abilities › Idea Generation and Reasoning Abilities › Inductive Reasoning

Combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).

Knowledge

English Language

Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Law and Government

Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

Administration and Management

Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

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