Claims Examiner

Claims examiners review claims after they are submitted to ensure claimants and adjusters followed proper guidelines. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Claims Examiner Job Description Template

Our company is looking for a Claims Examiner to join our team.

Responsibilities:

  • Contribute to the capture of critical data and to the development of analytical reports to our clients;
  • Review independent adjuster reports for accuracy;
  • Working for a Third Party Administrator in the Investigation, analysis, and direct oversight of full case load of first party property claims;
  • Be an organized, effective communicator, and possess excellent analytical, writing, negotiation, and follow-up skills;
  • Must be able to review insurance policy coverage, and prepare reservation of rights or declination letters when appropriate;
  • This position requires a high degree of knowledge with regard to all aspects of first and third party coverage;
  • Provide technical assistance and direction to your team members and be a party to their success;
  • Target identification of subrogation opportunities and lead recovery efforts;
  • Prepare proposed expense and loss reserve/settlement reports that exceed authority for submission;
  • Assess first party property and third party liability claims on a nationwide basis.

Requirements:

  • Strong computer skills required, including strong proficiency in Microsoft Office with an emphasis on Excel skills;
  • Post secondary education or related equivalent experience in the insurance or medical fields an asset;
  • Minimum of 2 years experience with billing or coding and/or insurance claim processing;
  • Exceptional verbal and written English communication skills with the ability to work independently but harmoniously within a team;
  • Knowledge of medical terminology an asset;
  • Ability to speak, read, and write fluently in other languages an asset.