Occupation Profile for 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.

Signficant Points

  • Employment is expected to increase moderately, but many job openings will arise from the need to replace workers who retire or leave for other reasons.
  • Licensing and continuing education requirements vary by State.
  • College graduates have the best opportunities; competition will be keen for jobs as investigators because this occupation attracts many qualified people.
 

Tasks

  • Core — 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.
  • Core — Pay and process claims within designated authority level.
  • Core — 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.
  • Core — Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Core — Confer with legal counsel on claims requiring litigation.

Activities

  • Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
  • 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.
  • Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
  • Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
  • Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.