Claims Examiner Job – How to Become a Claims Examiner

Claims Examiner Job plays a vital role in maintaining the integrity of the insurance industry by ensuring that claims are handled fairly, accurately, and following policy terms and applicable laws.

Claims Examiner Job
Claims Examiner Job

However, the major role is to assess claims and decide whether to approve, deny, or negotiate settlements based on the information provided and the terms of the insurance policy.

Well, these individuals carry out several activities and for you to understand better, this post will enlighten you more.

What is a Claims Examiner Job?

A claims examiner is a professional who works in the insurance industry and is responsible for reviewing insurance claims to determine their validity, accuracy, and compliance with insurance policies and regulations.

Claims Examiner Skills and Requirements

Skills and requirements are needed for the job of a claims examiner and they are stated below for you to have enlightenment on.

  • Entry-level positions require a high school diploma.
  • Finance or a closely related field bachelor’s degree is preferable.
  • Good organizational and administrative skills.
  • Excellent focus on detail.
  • Strong interpersonal abilities.
  • Outstanding written and verbal communication.
  • Proficiency in spreadsheets and mathematics.
  • Demonstrated the ability to make decisions.

Claims Examiner Roles

Roles are very important for claims examiners to carry out and some of their roles include;

  • Examine reports thoroughly to make sure the evaluation process is error-free.
  • Verify the reasonableness of rewards.
  • Accept, deny, or refer a claim to an expert.
  • Convene with claimants to resolve differences.
  • Ensure adherence to corporate policies and procedures as well as regulatory norms.
  • Help claims adjusters handle the number of cases by offering help.
  • Consult with experts including attorneys, engineers, architects, and doctors.
  • Assist lawyers and other experts in defending the business against claims.

How to Become a Claims Examiner

Becoming a claims examiner typically involves a combination of education, training, and gaining relevant experience in the field of insurance or claims management. Here are the steps you can follow to become a claims examiner.

Educational Background:

Obtain a high school diploma or GED. Focus on subjects related to mathematics, business, communication, and economics.

Bachelor’s Degree (Optional):

While not always required, having a bachelor’s degree in a relevant field such as business administration, finance, economics, or insurance can enhance your job prospects and provide a strong foundation for understanding insurance principles.

Gain Relevant Experience:

Look for entry-level positions in insurance companies, claims processing firms, or related organizations. Positions such as claims representative or customer service representative can provide valuable experience and insights into the claims industry.

Develop Skills:

Acquire skills essential for a claims examiner, including attention to detail, analytical thinking, communication skills, negotiation skills, and the ability to understand insurance policies and regulations.

Understand Insurance Policies and Regulations:

Study and familiarize yourself with different types of insurance policies, coverage options, regulations, and compliance requirements specific to the industry in which you want to work (e.g., health insurance, auto insurance, property insurance).

Professional Certification (Optional):

Consider obtaining relevant certifications to boost your credibility and marketability, such as the Associate in Claims (AIC) or Certified Insurance Service Representative (CISR) designation. These certifications are offered by organizations like The Institutes and can provide a competitive edge in the job market.


Attend industry-related events, join professional associations, and network with professionals in the field. This can help you gain insights, learn about job openings, and make valuable connections.

Apply for Claims Examiner Positions:

Look for job openings for claims examiner positions and apply to relevant opportunities. Tailor your resume and cover letter to highlight your education, skills, and experience related to claims processing.

Prepare for Interviews:

Research the company you’re applying to and familiarize yourself with common interview questions for claims examiner roles. Be prepared to discuss your relevant experiences, skills, and how you would handle different claims scenarios.

Excel in the Job:

Once you secure a claims examiner position, strive to perform your duties diligently, learn from your experiences, and continually improve your skills and knowledge in the field.

Career Advancement:

As you gain experience, consider pursuing higher-level positions within the claims department, such as senior claims examiner, claims supervisor, or claims manager, through additional education, certifications, and demonstrating exceptional performance.

Also, keep in mind that perseverance and dedication are crucial in any career path. Continuously educate yourself about changes in the insurance industry, stay updated on relevant laws and regulations, and seek opportunities for professional growth and development.

Claims Examiner Salary

In the United States, the average salary of a claims examiner is about $59,668 – $51,566 per year.

Frequently Asked Questions

Who is a claim examiner?

Insurance claims are examined by claims examiners to ensure that the investigation and reporting phases of a case are conducted by the law by both the claimant and the claim adjuster. Examiners of insurance claims make sure the law is followed, approve or reject insurance claims, and support adjusters as necessary.

What are the duties of an examiner?

To determine whether candidates have understood the topic and effectively presented it, examiners evaluate written, creative, and spoken assignments.

What is a claims verifier job description?

A claims verifier verifies and captures faxed, scanned, or emailed claims within a required period and at a required quality level.



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