How to Become a Claims Examiner

Insurance policies are very important in protecting assets against losses and damages. When insurance claims are filed trained professionals are required to review the claims to make sure the correct guidelines are followed. This is the job of claims examiners.

What does a claims examiner do?

Claims examiners evaluate claims that are made against insurance companies. They review the claims and determine if the proper procedures were followed. They make sure they have all of the correct information, consult with clients and insurance agents, and review the required reports and documents. They are responsible for keeping down the costs and recognizing fraud cases. They also approve and deny claims, set up settlements, and prepare reports summarizing claims. Most claims examiners work for life or health insurance companies. In life insurance companies, they assess causes of death and determine if new applicants have serious health conditions that make them at higher risk. In health insurance companies, claims examiners assess the claims to determine if the costs are reasonable for the specific condition.

What kind of training does a claims examiner need?

Claims examiners must have at least a high school diploma, but many have completed formal training. Many employers prefer candidates with bachelor degrees. Many claims examiners complete courses in business, mathematics, law, and economics. Those interested in examining medical claims also complete medical courses. Some prospective claims examiners complete work-study programs to gain practical experience. Most employers provide on the job training where new claims examiners work with experienced employees. Some states require claims examiners to be licensed. Licensing requirements typically include minimum education and experience and passing a written examination. Claims examiners must stay up to date on advancements in the field and often complete continuing education throughout their careers.

What are the prospects for a career as a claims examiner?

Employment of claims adjusters is expected to grow about as fast as average for all professions, increasing 9% from 2006 to 2016 (1). A growing population and increase in a variety of claims will drive job growth.

Job prospects are expected to be good with keen competition. Claims examiners with advanced education and extensive experience will have the best job opportunities. There will be many job openings from the need to replace claims examiners that retire, transfer, or leave the occupation for other reasons.

How much do claims examiners make?

As of November 2009, the middle 50% of claims examiners earn annual salaries between $33,008 and $42,520. The top 10% earn annual salaries of more than $48,001 (2).

A career as a claims examiner is an excellent choice for individuals interested in examining a variety of insurance claims. They must have a thorough knowledge of insurance policies and be able to complete a variety of tasks. Detail orientation, organization, and analytical thinking are desirable characteristics. Claims examiners must have excellent communication because they interact with many different clients and other professionals.

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