(Last Updated On: 05/04/2017)

Claims Examiner Job Description

When a person or business submits insurance claims, claims examiners review them to ensure that the adjusters and claimants have followed all of the necessary guidelines. They normally check for overpayments, underpayments, and other irregularities. If an error is found, they work with the adjuster to correct it.

The majority of examiners work for insurance companies, particularly in the life and health insurance fields.

When working for a health insurance company, claims examiners review insurance claims to determine if the cost is reasonable for the diagnosis and treatment provided. They can approve or deny a claim, or forward it to an investigator for further analysis.

In life insurance companies, claims examiners review the cause of death and authorize payments. They may also review applications, paying special attention to any pre-existing conditions that would put them at high risk.

Claims examiners spend most of their time working in an office environment. Most people in this occupation work full time, and are often to maintain a regular working schedule.

How to Become a Claims Examiner

A minimum of an associate’s degree is required to work as a junior examiner, but most companies prefer to hire candidates with a bachelor’s degree.

If you’re able to pursue a bachelor’s degree, you absolutely should. Without one, you opportunities for advancement in this field will be very limited.

Once hired, employers train claims examiners on the job. They normally start out working on small claims, and learn the basics of the occupation as they work under the supervision of a more experienced examiner. With time, they begin to take on more significant claims.

Many states require claims examiners to be licensed. The requirements for licensing vary from state to state, but normally include educational requirements and the successful completion of an exam. In other states, claims examiners are able to work under the company’s license and don’t need to earn a license themselves.

Related Occupations

Employment Outlook

There are currently 294,620 claims examiners in the United States, with 9,560 new claims examiner job openings created each year.

Claims Examiner jobs are not expected to see much growth beyond their current levels in the next decade.

Claims Examiner Salaries

Overall Salaries

Claims Examiner salaries can vary depending on your experience, the location, company, industry, and benefits provided. Nationwide, most claims examiners make between $44,500 – $73,700 per year, or $21.37 – $35.45 per hour.

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