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Claims Examiners, Property and Casualty Insurance - 13-1031.01

O*NET-SOC 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.

Sample of Reported Job Titles

  • Claims Adjuster
  • Claims Analyst
  • Claims Examiner
  • Claims Manager
  • Claims Representative
  • Claims Specialist
  • Claims Supervisor
  • Corporate Claims Examiner
  • Customer Care Specialist
  • Home Office Claim Specialist

SOC Occupation Groups

Related Occupations

Tasks

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

Detailed Work Activities

  • Advise others on financial matters.
  • Confer with others about financial matters.
  • Examine financial records.
  • Implement financial decisions.
  • Interview witnesses, suspects, or claimants.
  • Investigate legal issues.
  • Maintain data in information systems or databases.
  • Negotiate agreements to resolve disputes.
  • Pay charges, fees, or taxes.
  • Prepare financial documents.
  • Prepare operational reports.
  • Present business-related information to audiences.
  • Report information to managers or other personnel.
  • Supervise employees.
  • Verify accuracy of records.

Military Crosswalk Titles

  • Paralegal (Air Force - Enlisted)
  • Paralegal Apprentice (Air Force - Enlisted)
  • Paralegal Craftsman (Air Force - Enlisted)
  • Paralegal Helper (Air Force - Enlisted)
  • Paralegal Journeyman (Air Force - Enlisted)
  • Paralegal Superintendent (Air Force - Enlisted)

Apprenticeship Crosswalk Titles

No information available.

DOT Crosswalk Titles

  • Claim Examiner