Claims Examiners, Property And Casualty Insurance

Claims Examiners, Property and Casualty Insurance

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.

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

Knowledge

Customer and Personal Service: Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
English Language: Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Law and Government: Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
Administration and Management: Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
Mathematics: Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Clerical: Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
Computers and Electronics: Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

Skills

Reading Comprehension: Understanding written sentences and paragraphs in work related documents.
Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Active Listening: Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Writing: Communicating effectively in writing as appropriate for the needs of the audience.
Speaking: Talking to others to convey information effectively.

Abilities

Oral Comprehension: The ability to listen to and understand information and ideas presented through spoken words and sentences.
Oral Expression: The ability to communicate information and ideas in speaking so others will understand.
Written Comprehension: The ability to read and understand information and ideas presented in writing.
Inductive Reasoning: The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
Deductive Reasoning: The ability to apply general rules to specific problems to produce answers that make sense.
Written Expression: The ability to communicate information and ideas in writing so others will understand.
Problem Sensitivity: The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.

Work Activities

Resolving Conflicts and Negotiating with Others: Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
Identifying Objects, Actions, and Events: Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
Getting Information: Observing, receiving, and otherwise obtaining information from all relevant sources.
Organizing, Planning, and Prioritizing Work: Developing specific goals and plans to prioritize, organize, and accomplish your work.
Evaluating Information to Determine Compliance with Standards: Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
Communicating with Supervisors, Peers, or Subordinates: Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
Making Decisions and Solving Problems: Analyzing information and evaluating results to choose the best solution and solve problems.
Monitor Processes, Materials, or Surroundings: Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
Updating and Using Relevant Knowledge: Keeping up-to-date technically and applying new knowledge to your job.
Processing Information: Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.

Work Context

Telephone: How often do you have telephone conversations in this job?
Electronic Mail: How often do you use electronic mail in this job?
Letters and Memos: How often does the job require written letters and memos?
Indoors, Environmentally Controlled: How often does this job require working indoors in environmentally controlled conditions?
Importance of Being Exact or Accurate: How important is being very exact or highly accurate in performing this job?
Contact With Others: How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?
Frequency of Decision Making: How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?
Impact of Decisions on Co-workers or Company Results: How do the decisions an employee makes impact the results of co-workers, clients or the company?
Deal With External Customers: How important is it to work with external customers or the public in this job?
Frequency of Conflict Situations: How often are there conflict situations the employee has to face in this job?

Interests

Conventional: Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
Enterprising: Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
Investigative: Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Realistic: Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Social: Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Artistic: Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.

Work Style

Integrity: Job requires being honest and ethical.
Dependability: Job requires being reliable, responsible, and dependable, and fulfilling obligations.
Attention to Detail: Job requires being careful about detail and thorough in completing work tasks.
Stress Tolerance: Job requires accepting criticism and dealing calmly and effectively with high stress situations.
Self Control: Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
Cooperation: Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
Persistence: Job requires persistence in the face of obstacles.
Independence: Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
Analytical Thinking: Job requires analyzing information and using logic to address work-related issues and problems.
Adaptability/Flexibility: Job requires being open to change (positive or negative) and to considerable variety in the workplace.

Work Values

Support: Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
Independence: Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
Working Conditions: Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
Relationships: Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
Achievement: Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
Recognition: Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.

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Lay Titles

Case Manager

Check Examiner

Claim Auditor

Claims Account Manager

Claims Account Specialist

Claims Adjuster

Claims Analyst

Claims Auditor

Claims Director

Claims Examiner

Claims Manager

Claims Representative

Claims Specialist

Claims Supervisor

Claims Vice President

Customer Care Specialist

Home Office Claim Specialist

Insurance Auditor

Insurance Examiner

Liability Claims Manager

Liability Claims Representative

Litigation Examiner

Property Damage Claims Adjustor

Reinsurance Claim Analyst

Workers Compensation Claims Examiner

Workers Compensation Examiner

National Wages and Employment Info

Median Wages (2008):: $28.83 hourly, $59,960 annual.

Employment (2008):: 263,280 employees