Insurance Claim Examiner  What They Do

Just the Facts


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

This career is part of the Finance cluster Insurance pathway.


A person in this career:

  • Investigates, evaluates, and settles claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Adjusts reserves or provides reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Resolves complex, severe exposure claims, using high service oriented file handling.
  • Pays and processes claims within designated authority level.
  • Examines claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Verifies and analyzes data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Enters claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Confers with legal counsel on claims requiring litigation.
  • Contacts or interviews claimants, doctors, medical specialists, or employers to get additional information.
  • Maintains claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.

Working Conditions and Physical Demands

People who do this job report that:

  • You would sit most of the time. There's some walking and standing. You may have to lift and carry things like books, papers or tools weighing 10 lbs. or less.
  • Work in this occupation requires being inside most of the time
  • Sound and noise levels are loud and distracting
  • Work in this occupation involves making repetitive motions more than one-third of the time
  • Work in this occupation involves sitting more than one-third of the time

Working in this career involves (physical activities):

  • Seeing clearly up close
  • Speaking clearly enough to be able to be understood by others
  • Identifying and understanding the speech of another person

Work Hours and Travel

  • Irregular hours
  • Overnight travel

Specialty and Similar Careers

Careers that are more detailed or close to this career:

  • Case Manager -- Deals with individuals involved in accident claims to ensure that the individual receives the best possible options.
  • Insurance Auditor -- Settles insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures.
  • Litigation Examiner --