Claims examiner positions are available in a variety of insurance companies, including property and casualty, life, medical, and workers’ compensation. Claims examiner jobs are similar to claims adjuster jobs in the property and casualty industry, but claims examiners work on larger, more complicated claims. Medical claims examiners work in a similar way to medical billing specialists, and life insurance examiners do both underwriting and claims-related work.
The claims examiner’s job entails a few basic functions, regardless of the type of insurance. These tasks include thoroughly reviewing cases, ensuring proper claim handling, gathering information, and authorizing payment when necessary. The job necessitates meticulous attention to detail as well as a working knowledge of medical terminology and coding.
The job description of an insurance claims examiner entails reviewing large or complex claims that the claims adjuster has been unable to resolve. As an extra set of eyes to monitor and direct the claim, a claims examiner is assigned to the case. The claims examiner will check on the case on a regular basis and review the claim to ensure that the case is being handled properly.
Claim examiners must also keep meticulous records. To ensure that all facts about the claim are considered in the case’s handling, the examiner must record all conversations and transactions. Many claim examiners are required to submit detailed reports on the status of a claim on a regular basis for review claims managers.
Medical coding is a requirement for claims examiner jobs at medical and health insurance companies. Examiners look over claims to make sure the charges are reasonable, based on the medical diagnosis and procedures that have been approved. Medical claims examiners also make sure that the hospital stay is appropriate for the patient’s diagnosis and treatment.
Insurance examiners for workers’ compensation work to ensure that claimants are properly compensated, based on the injury diagnosis and the expected length of disability for such an injury. They’ll figure out how much workers should be paid in disability and lost wages, and they’ll work with medical providers to make sure billing is accurate and fair. They’ll also order independent medical exams and make sure the injured worker fills out all of the necessary paperwork.
Jobs as a life insurance claims examiner include both claims and underwriting responsibilities. These examiners will review applications and conduct investigations to ensure that no serious illnesses exist that would put an applicant at risk. The claims examiner will also look over sensitive information like the cause of death and may need to speak with family members.