Claims Examiner
Job Summary
Responsible for reviewing claims after they are submitted to ensure proper guidelines and processes have been followed. Assists adjusters with complicated claims.
Primary Responsibilities
- Ensure proper guidelines were followed during claim phases.
- Review claims to determine if costs were reasonable.
- Check applications for completeness and accuracy.
- Consult policy files to verify information reported in a claim.
- Inspect property damage to determine extent of damages.
- Evaluate damages to ascertain compensation amount.
- Consult police and hospital records.
- Consult with accountants, architects, construction workers, engineers, lawyers, and physicians to get expert evaluation.
- Examine photographs and statements.
- Listen to or watch audio or video surveillance.
- Record data and statements in report.
- Evaluate all information to determine how claim should be handled.
- Negotiate with claimant to settle claim.
- Work with attorneys to defend insurer's position is claim is contested.
- Issue payout amounts.
- Prepare and present claims to insurance companies.
- Review new applications for life insurance to make sure that the applicants have no serious illnesses that would make them a high risk to insure.
