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Claims Examiner Job Description

What does a Claims Examiner do?

A Claims Examiner is responsible for evaluating insurance claims made by clients, investigating facts, and determining the validity and amount of claims. They review insurance policies, medical records, and other relevant information to make informed decisions. The role involves communicating with policyholders, medical professionals, and attorneys to gather necessary information to make accurate claims decisions. Claims Examiners also ensure that all legal and regulatory requirements are met, and that claims are processed in a timely and efficient manner. They often work for insurance companies or third-party administrators of insurance programs.

Our Claims Examiner job description includes the Claims Examiner responsibilities, duties, skills, education, qualifications, and experience.

Claims Examiner Example

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If you need an example job description for a Claims Examiner download the one below, alternatively we have many other Banking and Insurance job description samples and a job description library with over 3000 job descriptions templates that you can download for free.

What does a Claims Examiner do?

A Claims Examiner is responsible for reviewing and processing insurance claims in accordance with company guidelines and procedures. They must investigate and evaluate claims to ensure accurate and timely processing of claims and payment of benefits to claimants.

The Claims Examiner must have a detailed knowledge of claims processing procedures, insurance product knowledge, and excellent communication and customer service skills. They must remain up to date with changes in relevant regulations, policies, and procedures.

The Claims Examiner is responsible for evaluating claims, determining coverage, and making decisions related to payment of benefits. They must accurately assess and investigate claims, examine documents, and make decisions related to the legitimacy of claims.

The Claims Examiner must be able to work independently, manage multiple tasks, and make timely decisions. They must also be able to communicate effectively with claimants to ensure resolution of claims.

Claims Examiner Role Purpose

The primary purpose of a Claims Examiner is to evaluate, process and settle insurance claims. This involves assessing the legitimacy of a claim, investigating the facts and circumstances of the claim, and making decisions about the appropriate course of action. Claims Examiners also often liaise with claimants, insurers, brokers and other parties to ensure the smooth processing of claims. In addition, Claims Examiners may also be responsible for providing advice to claimants and insurers regarding the claim process and resolving disputes.

Claims Examiner Role

A Claims Examiner is responsible for assessing and processing insurance claims in an accurate and timely manner. They review, investigate and evaluate claims to ensure they are compliant with company and industry standards, and provide a customer service experience that meets customer expectations.

Claims Examiner Duties

  • Assess claims for eligibility and accuracy
  • Investigate and verify the facts of a claim
  • Analyse relevant documentation
  • Calculate benefits and payments due
  • Provide customer service and advice
  • Make decisions on claims

Claims Examiner Requirements

  • Experience in insurance or legal field
  • Excellent customer service skills
  • Good organisational and communication skills
  • Knowledge of relevant legal regulations and procedures
  • Ability to work under pressure
  • Strong attention to detail

Claims Examiner Skills

  • Excellent communication and interpersonal skills
  • Ability to work under pressure and to tight deadlines
  • Accuracy and attention to detail
  • Proficient in Microsoft Office
  • Excellent organisational skills

Claims Examiner Personal Traits

  • Analytical
  • Organised
  • Attentive
  • Good communication skills

How to write a Claims Examiner Job Advert

Use our job advert template to write a job advert for posting on job sites and job boards. Our job advertising templates are carefully created to help you reach your audience and beat the competition to the best talent.

A job description informs the reader about a job, whereas a job advert’s main objective is to sell the job opportunity to attract as many suitable applicants possible. A job advert maybe the first touch-point a candidate has with your company so it is important to create a great impression.

Job Advertisements should enticing, so considering using short, exciting language which get the reader’s attention.

How to write a Claims Examiner Job Description

To write a job description, we recommend starting with a job description template from our job description library, which contains examples for 800+ positions and professions. Our job description examples include a job summary with duties and responsibilities and skills and requirements, which can be personalised for your job vacancy.

Job Description Advice - Guidance on How to Personalise a Claims Examiner Job Specification

The hiring process and recruiting new employees to fill your key roles requires a degree of personalisation if you are to attract the best employees in a competitive employment market. The right person for a crucial role or more senior roles will likely have other employers targeting them. As your job description will be the first point of contact, you need to nail your pitch and provide the best possible service.

Job Description Tips - Help on formatting a Claims Examiner Job Specification

When creating your bespoke description and advert, you should cover and promote these points:

Job title: This should accurately reflect the role and include keywords that top talent might be using to search for jobs.

Job duties: The day to day duties, such as administrative tasks, which vary depending on the company and inform the candidate if they can complete the role.

Technical skills: These are the hard skills required through training, such as proficiency with Microsoft Office.

Soft skills: These include the interpersonal skills and general abilities the right candidates will possess. For example, the competency to prioritise multiple tasks, handle customer queries and customer complaints, work alone, or build a good relationship with coworkers.

The company's culture: Highlighting your company culture and values ensures employees thrive and find outstanding job satisfaction. Candidates that are not the right fit won’t waste their time completing the application process, meaning you can focus on qualified individuals and hire in a more timely manner.

Career progression: Including the career path will entice candidates looking for career growth. 

Training and development programs: Smaller companies may need employees with previous experience or provide educational assistance over internal training offered by larger organisations with more significant resources. 

Employee benefits: Compensation and benefits often fail to appear in job ads and while you may want to hold your cards close to your chest, failing to include them is a mistake. Consider answering common questions, such as working hours and paid leave. Researching the average salary for the role in these early stages will ensure you don’t waste your interviewer’s and the candidate’s time.

Skill gaps: Your company may need to bring in new skills beyond those required to complete the key role and duties. Thinking on an organisational level can be beneficial when contemplating skills diversity.

Legal requirements: Ensure your job advert and description does not ask for inappropriate or discriminatory personal details, such as age, marital status, or religion.

How to Hire a Claims Examiner

Once you have selected your Job Description download it or convert it to a Job Advert. From here you can post/advertise your job across our network of job boards. If you wish to use the job description for a CV Template click through for advice and Convert to a CV

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