Claims Examiner Property Casualty Insurance Job 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 Performed

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

Work Activities

  • communicate technical information
  • compile information through interviews
  • confer with prosecuting attorney
  • develop management control systems
  • direct and coordinate activities of workers or staff
  • examine documents for completeness, accuracy, or conformance to standards
  • follow contract, property, or insurance laws
  • investigate insurance claims
  • maintain insurance records
  • maintain records, reports, or files
  • make presentations
  • note discrepancies in financial records
  • obtain information from individuals
  • prepare reports
  • recommend claim action
  • review data on insurance applications or policies
  • use computers to enter, access or retrieve data
  • use interviewing procedures
  • use knowledge of investigation techniques
  • verify investigative information

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