Insurance Claims examiners work within property and casualty insurance firms and may have duties similar to those of an adjuster, but often their primary job is to review claims after they are submitted in order to ensure that proper guidelines have been followed. They may assist adjusters with complicated claims or when, for instance, a natural disaster suddenly greatly increases the volume of claims.Most claims examiners work for life or health insurance companies. In health insurance companies, examiners review health-related claims to see whether costs are reasonable given the diagnosis. They use guides that have information on the average period of disability, expected treatments, and average hospital stays for various ailments. Examiners check claim applications for completeness and accuracy, interview medical specialists, and consult policy files to verify the information reported in a claim. They then authorize appropriate payment, deny the claim, or refer the claim to an insurance claim investigator for a more thorough review.
Claims examiners must keep careful records detailing the outcome of each step in the settlement process. They are often responsible for preparing summary reports for claims filed, and sometimes must testify in court, making careful record-keeping a crucial aspect of their job.
In life insurance, claims examiners review the causes of death, particularly in the case of an accident, since most life insurance policies pay additional benefits if a death is accidental. Claims examiners also may 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.
Insurance Claims adjusters investigate insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability.
Insurance Claims Investigators look into the background of claimants, witnesses and anyone else who has made a statement regarding the case, like medical professionals or police officers. They review the circumstances of the case through research, interviews, surveillance and in-person inspections of sites and vehicles, writing reports on their findings.