Claims Examiners, Property and Casualty Insurance
SOC: 13-1031.01

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.


National Salary Information:

Hourly Statistics:

Annual Statistics:

Source: Bureau of Labor Statistics 2015 wage data.


Employment Projections:

Employment (2014):
299,700 employed

Projected (2024):
309,500 employed

Projected growth (2014-2024)


Source: Bureau of Labor Statistics 2015 2014-2024 employment projections external site. "Projected growth" represents the estimated change in total employment over the projections period (2014-2024). "Projected job openings" represent openings due to growth and replacement.


Alternate Titles:

  • Case Manager
  • Casualty Claims Supervisor
  • Check Examiner
  • Claim Auditor
  • Claims Account Manager
  • Claims Account Specialist
  • Claims Adjuster
  • Claims Analyst
  • Claims Auditor
  • Claims Consultant
  • Claims Director
  • Claims Examiner
  • Claims Manager
  • Claims Representative
  • Claims Specialist
  • Claims Supervisor
  • Claims Vice President
  • Corporate Claims Examiner
  • Customer Care Specialist
  • Executive Relations Specialist
  • Home Office Claim Specialist
  • Home Office Claims Examiner
  • Insurance Auditor
  • Insurance Examiner
  • Liability Claims Examiner
  • Liability Claims Manager
  • Liability Claims Representative
  • Litigation Examiner
  • Property Damage Claims Adjustor
  • Reinsurance Claim Analyst
  • Worker's Compensation Claims Examiner
  • Workers Compensation Claims Examiner
  • Workers Compensation Examiner


  • Job Zone Four: Considerable Preparation Needed

    Experience:

    A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.

    Education:

    Most of these occupations require a four-year bachelor's degree, but some do not.

    Job Training:

    Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.


    Required Skills:

  • Reading Comprehension
  • Active Listening
  • Writing
  • Speaking
  • Mathematics
  • Critical Thinking
  • Active Learning
  • Learning Strategies
  • Monitoring
  • Social Perceptiveness
  • Coordination
  • Persuasion
  • Negotiation
  • Instructing
  • Service Orientation
  • Complex Problem Solving
  • Technology Design
  • Programming
  • Operation Monitoring
  • Troubleshooting
  • Quality Control Analysis
  • Judgment and Decision Making
  • Systems Analysis
  • Systems Evaluation
  • Time Management
  • Management of Financial Resources
  • Management of Material Resources
  • Management of Personnel Resources

  • Knowledge Used:

  • Administration and Management
  • Clerical
  • Economics and Accounting
  • Sales and Marketing
  • Customer and Personal Service
  • Personnel and Human Resources
  • Production and Processing
  • Computers and Electronics
  • Design
  • Building and Construction
  • Mechanical
  • Mathematics
  • Physics
  • Chemistry
  • Psychology
  • Sociology and Anthropology
  • Geography
  • Medicine and Dentistry
  • Therapy and Counseling
  • Education and Training
  • English Language
  • Foreign Language
  • Philosophy and Theology
  • Public Safety and Security
  • Law and Government
  • Telecommunications
  • Communications and Media
  • Transportation


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

  • Tools & Technology:

  • Desktop computers
  • Notebook computers
  • Personal computers
  • Personal digital assistants PDA
  • Scanners
  • Tablet computers
  • 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
  • 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 Appraisal Quality Solution
  • 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
  • Healthcare common procedure coding system HCPCS software
  • 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
  • Microsoft Excel
  • Microsoft Office software
  • Microsoft PowerPoint
  • Microsoft Word
  • StrataCare StrataWare eReview
  • Tropics Claims Reserve Management


  • business and financial operations


    industry stats

    SOC: 13-0000

    Total Employed: 7,032,560

    Average Annual Salary: $73,800