Insurance Claims Examiner: Job Duties, Skills and Salary 2025

What does an Insurance Claims Examiner do?

An Insurance Claims Examiner is responsible for reviewing insurance claims to ensure accuracy and compliance with policy terms and legal requirements. They verify the details of claims, assess the validity of the claim, and determine the appropriate payout based on the policy and the circumstances of the claim. Claims Examiners work closely with adjusters, policyholders, and legal teams to resolve any disputes or discrepancies in the claims process. Their role is crucial in minimizing fraud and ensuring that claims are processed efficiently and fairly, protecting the financial integrity of the insurance company.

Through careful examination and analysis, they ensure that claims are paid out correctly and in accordance with policy terms, safeguarding both the insurer and the insured.

Insurance Claims Examiner: Main duties

Insurance Claims Examiners in the Insurance field handle essential tasks and contribute significantly to achieving team and organizational goals. Here are some of their primary responsibilities:

• Review insurance claims to ensure they are complete and comply with policy terms.
• Verify the accuracy of claims by checking all necessary documentation, including medical reports, police reports, and witness statements.
• Assess the validity of claims and determine the appropriate amount to be paid out based on the policy.
• Collaborate with claims adjusters to investigate complex claims or claims involving large sums of money.
• Resolve discrepancies or disputes by coordinating with legal teams, policyholders, and adjusters.
• Document and report on the outcomes of claims reviews, including reasons for approval or denial.
• Monitor claims for potential fraud and take appropriate action if fraud is suspected.

Insurance Claims Examiner: Key Qualifications

• Bachelor's degree in finance, business, insurance, or a related field.
• Experience in insurance claims, underwriting, or a related field is preferred.
• Knowledge of insurance policy language, claims processes, and relevant laws and regulations.
• Professional certifications such as Associate in Claims (AIC) or Certified Insurance Examiner (CIE) are beneficial.

Basic Skills and Requirements for Insurance Claims Examiners

• Strong analytical skills to assess claims and make informed decisions.
• Attention to detail to ensure accuracy and compliance in claims processing.
• Excellent communication skills for interacting with adjusters, policyholders, and legal teams.
• Good organizational skills to manage multiple claims simultaneously.
• Integrity and ethical judgment in handling sensitive and confidential information.

Salary Expectations for Insurance Claims Examiners

The average salary for an Insurance Claims Examiner in the U.S. is approximately $68,000 per year and can vary from entry-level to senior positions. Insurance Claims Examiners may receive a wide range of benefits.

To explore more detailed salary information, including specific salary estimates in your country, visit the Insurance Claims Examiner Salary Country Overview.