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.
- Case Manager
- Casualty Claims Supervisor
- Check Examiner
- Claim Auditor
- Claims Account Manager
- Claims Account Specialist
- Claims Adjuster
- Claims Analyst
- Claims Auditor
- Claims Director
- 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.
People who work in this occupation generally have the interest code: CE.
This means people who work in this occupation generally have Conventional interests, but also prefer Enterprising environments.
People who work in this occupation generally prize Support, but also value Independence and Working Conditions in their jobs.
- 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.
- 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.
- Writing - Communicating effectively in writing as appropriate for the needs of the audience.
- 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.
- Speaking - Talking to others to convey information effectively.
- 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.
- Negotiation - Bringing others together and trying to reconcile differences.
- Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.
Most of these occupations require a four-year bachelor's degree, but some do not.
In 2013, the average annual wage in United States was $62,340 with most people making between $37,220 and $90,570
During 2010, this occupation employed approximately 280,000 people in United States. It is projected that there will be 288,000 employed in 2020.
This occupation will have about 0 openings due to growth and about 79,000 replacement openings for approximately 79,000 total annual openings.
majorBusiness Administration and Management, General
onetInsurance Adjusters, Examiners, and Investigators
majorHealth/Medical Claims Examiner
collegeUniversity of Southern California
collegeCalifornia State University-Long Beach
collegeCity College of San Francisco