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Career: Claims Examiners, Property and 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.


Job Tasks

Importance %age

Task Description
100
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.
99
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
94
Confer with legal counsel on claims requiring litigation.
93
Resolve complex, severe exposure claims, using high service oriented file handling.
92
Pay and process claims within designated authority level.
87
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
85
Present cases and participate in their discussion at claim committee meetings.
80
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.
72
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
71
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
69
Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
61
Conduct detailed bill reviews to implement sound litigation management and expense control.
59
Report overpayments, underpayments, and other irregularities.
52
Communicate with reinsurance brokers to obtain information necessary for processing claims.
48
Prepare reports to be submitted to company's data processing department.
41
Supervise claims adjusters to ensure that adjusters have followed proper methods.

Work Activities

Importance %age

Activity Description
79
Resolving Conflicts and Negotiating with Others
  • Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
    		•
    74
    		Identifying Objects, Actions, and Events
  • Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
    		•
    73
    		Getting Information
  • Observing, receiving, and otherwise obtaining information from all relevant sources.
    		•
    73
    		Organizing, Planning, and Prioritizing Work
  • Developing specific goals and plans to prioritize, organize, and accomplish your work.
    		•
    71
    		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.
    		•
    70
    		Communicating with Supervisors, Peers, or Subordinates
  • Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
    		•
    69
    		Making Decisions and Solving Problems
  • Analyzing information and evaluating results to choose the best solution and solve problems.
    		•
    68
    		Processing Information
  • Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
    		•
    68
    		Monitor Processes, Materials, or Surroundings
  • Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
    		•
    68
    		Updating and Using Relevant Knowledge
  • Keeping up-to-date technically and applying new knowledge to your job.
    		•
    66
    		Establishing and Maintaining Interpersonal Relationships
  • Developing constructive and cooperative working relationships with others, and maintaining them over time.
    		•
    62
    		Communicating with Persons Outside Organization
  • Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
    		•
    60
    		Judging the Qualities of Things, Services, or People
  • Assessing the value, importance, or quality of things or people.
    		•
    60
    		Documenting/Recording Information
  • Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
    		•
    57
    		Interacting With Computers
  • Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
    		•
    56
    		Analyzing Data or Information
  • Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
    		•
    55
    		Performing for or Working Directly with the Public
  • Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.
    		•
    54
    		Thinking Creatively
  • Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
    		•
    52
    		Monitoring and Controlling Resources
  • Monitoring and controlling resources and overseeing the spending of money.
    		•
    48
    		Inspecting Equipment, Structures, or Material
  • Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.
    		•
    46
    		Estimating the Quantifiable Characteristics of Products, Events, or Information
  • Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.
    		•
    45
    		Developing Objectives and Strategies
  • Establishing long-range objectives and specifying the strategies and actions to achieve them.
    		•
    45
    		Interpreting the Meaning of Information for Others
  • Translating or explaining what information means and how it can be used.
    		•
    45
    		Coaching and Developing Others
  • Identifying the developmental needs of others and coaching, mentoring, or otherwise helping others to improve their knowledge or skills.
    		•
    44
    		Scheduling Work and Activities
  • Scheduling events, programs, and activities, as well as the work of others.
    		•
    44
    		Performing Administrative Activities
  • Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
    		•
    42
    		Coordinating the Work and Activities of Others
  • Getting members of a group to work together to accomplish tasks.
    		•
    40
    		Assisting and Caring for Others
  • Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.
    		•
    38
    		Guiding, Directing, and Motivating Subordinates
  • Providing guidance and direction to subordinates, including setting performance standards and monitoring performance.
    		•
    35
    		Training and Teaching Others
  • Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.
    		•
    33
    		Developing and Building Teams
  • Encouraging and building mutual trust, respect, and cooperation among team members.
    		•
    33
    		Provide Consultation and Advice to Others
  • Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics.
    		•
    32
    		Selling or Influencing Others
  • Convincing others to buy merchandise/goods or to otherwise change their minds or actions.
    		•
    24
    		Staffing Organizational Units
  • Recruiting, interviewing, selecting, hiring, and promoting employees in an organization.
    		•
    20
    		Handling and Moving Objects
  • Using hands and arms in handling, installing, positioning, and moving materials, and manipulating things.
    		•
    16
    		Controlling Machines and Processes
  • Using either control mechanisms or direct physical activity to operate machines or processes (not including computers or vehicles).
    		•
    12
    		Performing General Physical Activities
  • Performing physical activities that require considerable use of your arms and legs and moving your whole body, such as climbing, lifting, balancing, walking, stooping, and handling of materials.
    		•
    7
    		Operating Vehicles, Mechanized Devices, or Equipment
  • Running, maneuvering, navigating, or driving vehicles or mechanized equipment, such as forklifts, passenger vehicles, aircraft, or water craft.
    		•
    6
    		Repairing and Maintaining Electronic Equipment
  • Servicing, repairing, calibrating, regulating, fine-tuning, or testing machines, devices, and equipment that operate primarily on the basis of electrical or electronic (not mechanical) principles.
    		•
    1
    		Drafting, Laying Out, and Specifying Technical Devices, Parts, and Equipment
  • Providing documentation, detailed instructions, drawings, or specifications to tell others about how devices, parts, equipment, or structures are to be fabricated, constructed, assembled, modified, maintained, or used.
    		•
    0
    		Repairing and Maintaining Mechanical Equipment
  • Servicing, repairing, adjusting, and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical (not electronic) principles.
    		•
    
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