Insurance Claims Examiner: Career and Salary Facts

Insurance claims examiners research claims to determine if they should be approved or denied. Find out what the job duties are; get information on education, licensing and certification requirements; and check out the average salary for an insurance claims examiner. Schools offering Risk Management degrees can also be found in these popular choices.

What Is an Insurance Claims Examiner?

Insurance claims examiners research claims to determine if they should be approved or denied. In general, you'll be responsible for evaluating insurance claims to verify that the claims are legitimate and that they meet the standards necessary for payment. This process involves finding out the specific details of the claim, analyzing the damage done and making sure the payout from the insurance company is fair. You'll need to make sure that the claims are not fraudulent and may need to contact claimants' doctors or employers to do so. Most claims examiners work for life or health insurance companies. Look through the chart below to help you decide if a career as an insurance claims examiner is a good fit for you.

Degree Required High school diploma; postsecondary training preferred
Training RequiredOn-the-job training
Licensure RequiredLicensure requirements vary by state
Job Growth (2014-2024)3% increase for claims adjusters, examiners and investigators*
Average Salary (2015)$64,300 for claims adjusters, examiners and investigators*

Source: *U.S. Bureau of Labor Statistics

What Are the Responsibilities of an Insurance Claims Examiner?

Your responsibilities as an insurance claims examiner will vary with the type of insurance that you are hired to manage. However, your primary role - regardless of the type of insurance - is to analyze the factors that are germane to insurance claims and verify that specific protocols, guidelines and requirements are met prior to payment approvals. For instance, if you are a health insurance claims examiner, you review medical, prescription or dental claims that are usually submitted by healthcare providers. You verify that diagnoses and treatments rendered are comparably appropriate to the costs claimed.

As a property and casualty insurance claims examiner, you handle claims associated with vehicles, buildings, businesses and land rights. You review an array of cases pertaining to loss or damage-causing incidents, such as natural disasters, accidents and vandalism. If you are employed as a life insurance claims examiner, you evaluate causes of death and assess risks on new applicants.

What Education Do I Need?

The U.S. Bureau of Labor Statistics (BLS) reports that you don't necessarily need a formal education beyond high school to enter the workforce as an insurance claims examiner (www.bls.gov). However, having a college degree and/or professional training or experience in a related field is preferred by most employers. Related fields not only include insurance, but also fields that are associated with the nature of specific claim types. For example, working in a medical office can provide skills and experience that may benefit you as a claims examiner for health insurance.

Once you become an insurance claims examiner, continuing professional education is crucial. This is because of the changing nature of laws, products, services and procedures that affect how certain claims should be handled. While some employers offer continuing education to their employees, it also is available through trade associations and schools, including online seminar or coursework opportunities.

Do I Need a License or Certification?

Your licensing requirements as an insurance claims examiner will vary with each state. Some states require the completion of a licensing exam, while others allow examiners to work under their employer's license. Some states also allow professional certification as a substitute for an examination. Check with your state authority for specific licensing information.

Some employers may prefer or require examiners to have professional certification. Certification can be offered through trade organizations such as the International Claim Association. The phrase 'professional certification' is sometimes used synonymously with 'professional designation.'

What Salary Can I Earn?

According to the BLS, claims adjusters, examiners and investigators earned an average annual salary of $64,300 in May 2015. Those working for the federal government earned a higher average of $70,470 for the same time period.

What Are Some Related Alternative Careers?

For individuals with an interest in the insurance industry, there are a number of other career options. You could also work as an insurance claims adjuster or appraiser, both of which are jobs that require similar skill sets. Adjusters help determine how much insurance companies should pay for loss or damages, while appraisers estimate the value of insured items. With a bachelor's degree, you could also become an appraiser or assessor of real estate. This involves viewing real estate properties to estimate their value before they go on the market for sale or before they are taxed, mortgaged or insured.

To continue researching, browse degree options below for course curriculum, prerequisites and financial aid information. Or, learn more about the subject by reading the related articles below:

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