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Claims Examiners, Property and Casualty Insurance

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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.

    Work Activities
    • 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.
    • Supervise claims adjusters to ensure that adjusters have followed proper methods.
    • 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.
    • Conduct detailed bill reviews to implement sound litigation management and expense control.
    • 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.
    • Report overpayments, underpayments, and other irregularities.
    • Present cases and participate in their discussion at claim committee meetings.
    • Communicate with reinsurance brokers to obtain information necessary for processing claims.
    • Prepare reports to be submitted to company's data processing department.
    Skills
    • Reading Comprehension

      Understanding written sentences and paragraphs in work related documents.

    • Writing

      Communicating effectively in writing as appropriate for the needs of the audience.

    • 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.

    WorkKeys®
    Applied Math
    5
    Workplace Documents
    5
    Graphic Literacy
    4
    Abilities
    • Oral Comprehension

      The ability to listen to and understand information and ideas presented through spoken words and sentences.

    • Written Comprehension

      The ability to read and understand information and ideas presented in writing.

    • Deductive Reasoning

      The ability to apply general rules to specific problems to produce answers that make sense.

    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.

    Career Video
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    Pay
    • Ohio Annual Salary $65,000/yr
    • Typical Salary
    • Ohio Hourly Wage $31.25/hr
    • Typical Hourly Wage
    Ohio Employment Trends
    • Currently Employed 11,380
    • Yearly Projected Openings 880
    Typical Education
    Personality
    Conventional: People interested in this work like activities that include data, detail, and regular routines. They do well at jobs that need:
    • Integrity
    • Dependability
    • Attention to Detail
    • Stress Tolerance
    • Self Control
    • Cooperation
    Tools
    • Tablet computers
    • Personal digital assistant PDAs or organizers
    • Personal computers
    • Notebook computers
    • Desktop computers
    Technology
    • Medical software
    • Expert system software
    • Document management software
    • Data base user interface and query software
    • Analytical or scientific software
    Tags
    • InDemand occupations are considered a priority by the state of Ohio.