Insurance claims examiners work in various types of insurance companies, including property and casualty, life, health care, and workers’ compensation. They review large or complex claims, verify proper handling of complaints, gather facts, and authorize payment where appropriate. They also keep careful records and may submit periodic reports. Medical claims examiners review claims to ensure charges are reasonable and hospital stays are reasonable for the diagnosis and treatment. Workers’ compensation examiners calculate correct disability and lost wages and work with medical providers to ensure billing is accurate. Life insurance examiners review applications and investigate to verify no serious conditions and review confidential information, such as the cause of death.
Insurance claims examiner jobs exist in various types of insurance companies such as property and casualty, life, health care and workers compensation. Claims examiner jobs in the property and casualty industry are similar to claims adjusters, but the claims examiner works on large, complicated claims. Medical claims examiner jobs are similar to medical billing specialist and life insurance examiners do a mix of underwriting and claims-related work.
No matter the type of insurance, the claims examiner’s job involves some basic duties. This includes carefully reviewing cases, verifying proper handling of complaints, gathering facts and authorizing payment where appropriate. The job requires close attention to detail, along with an understanding of medical terminology and medical coding.
The insurance claims examiner’s job description involves reviewing large or complex claims that the claims adjuster cannot resolve. The claims examiner is co-assigned to the case as an extra set of eyes to monitor and direct the claim. The Complaints Examiner will review the case at regular intervals and review the complaint to ensure the handling of the case follows proper guidelines.
Claims examiner jobs also involve careful record keeping. The examiner must detail all conversations and transactions to ensure that all facts about the complaint are considered in handling the case. Many claims examiners are required to submit periodic detailed reports on the status of a claim for review by claims managers.
Claims examiner jobs at medical and health insurance companies involve medical coding. Examiners review claims to ensure that charges are reasonable, based on the physician’s diagnosis and approved medical procedures. Medical claims examiners also ensure that the hospital stay is reasonable for the diagnosis and treatment the patient receives.
Workers Compensation Insurance Examiners work to ensure that claimants are paid adequately by referencing the injury diagnosis and expected duration of disability for such injury. They will calculate correct disability and lost wages for workers and work with medical providers to ensure billing is accurate and fair. They will also order independent medical examinations and ensure that the injured worker completes all claim documentation properly.
Life insurance claims examiner jobs include claims duties and some underwriting-related duties. These examiners will review applications and investigate to verify that there are no serious conditions that could make an applicant at high risk. The claims examiner will also review confidential information, such as the cause of death, and may need to interview family members.
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