Summary Report for:
13-1031.01 - Claims Examiners, Property and Casualty Insurance
Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.
Sample of reported job titles:
Claims Examiner, Claims Adjuster, Claims Specialist, Claims Manager, Claims Representative, Customer Care Specialist, Claims Analyst, Claims Supervisor, Home Office Claim Specialist, Litigation Examiner
Tasks | Tools & Technology | Knowledge | Skills | Abilities | Work Activities | Work Context | Job Zone | Interests | Work Styles | Work Values | Related Occupations | Wages & Employment
Tasks
- Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Pay and process claims within designated authority level.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Present cases and participate in their discussion at claim committee meetings.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
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Tools & Technology
Tools used in this occupation:
| Desktop computers |
| Notebook computers |
| Personal computers |
| Personal digital assistant PDAs or organizers — Personal digital assistants PDA |
| Tablet computers |
Technology used in this occupation:
| Access software — CCC EZNet electronic communications network; CSC Automated Work Distributor AWD |
| Analytical or scientific software — Insurance claims fraud detection software; Magnify Predictive Targeting System |
| Data base user interface and query software — Claims processing administration and management software; Fair Isaac Claims Advisor; Tropics Claims Reserve Management |
| Document management software — Agency Management Systems AMS 360; atGlobal Allegro; BCCORP W5 for Adjusters; InSystems Calligo Document Management System |
| Expert system software — atGlobal webMBR; Axonwave Fraud and Abuse Management System; LexisNexis RiskWise; StrataCare StrataWare eReview |
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Knowledge
| English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. |
| Customer and Personal Service — Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction. |
| Law and Government — Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process. |
| Clerical — Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology. |
| Computers and Electronics — Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming. |
| Mathematics — Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications. |
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Skills
| Reading Comprehension — Understanding written sentences and paragraphs in work related documents. |
| Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one. |
| Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times. |
| Time Management — Managing one's own time and the time of others. |
| Writing — Communicating effectively in writing as appropriate for the needs of the audience. |
| Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. |
| Speaking — Talking to others to convey information effectively. |
| Active Learning — Understanding the implications of new information for both current and future problem-solving and decision-making. |
| Negotiation — Bringing others together and trying to reconcile differences. |
| Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. |
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Abilities
| Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense. |
| Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences. |
| Oral Expression — The ability to communicate information and ideas in speaking so others will understand. |
| Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events). |
| Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem. |
| Written Comprehension — The ability to read and understand information and ideas presented in writing. |
| Information Ordering — The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations). |
| Speech Clarity — The ability to speak clearly so others can understand you. |
| Speech Recognition — The ability to identify and understand the speech of another person. |
| Near Vision — The ability to see details at close range (within a few feet of the observer). |
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Work Activities
| Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources. |
| Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail. |
| Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information. |
| Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form. |
| Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person. |
| Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems. |
| Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time. |
| Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards. |
| Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used. |
| Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork. |
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Work Context
| Structured versus Unstructured Work — To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals? |
| Face-to-Face Discussions — How often do you have to have face-to-face discussions with individuals or teams in this job? |
| Indoors, Environmentally Controlled — How often does this job require working indoors in environmentally controlled conditions? |
| Spend Time Sitting — How much does this job require sitting? |
| Importance of Being Exact or Accurate — How important is being very exact or highly accurate in performing this job? |
| Contact With Others — How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it? |
| Freedom to Make Decisions — How much decision making freedom, without supervision, does the job offer? |
| Telephone — How often do you have telephone conversations in this job? |
| Frequency of Decision Making — How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization? |
| Time Pressure — How often does this job require the worker to meet strict deadlines? |
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Job Zone
| Title |
Job Zone Three: Medium Preparation Needed |
| Overall Experience |
Previous work-related skill, knowledge, or experience is required for these occupations. For example, an electrician must have completed three or four years of apprenticeship or several years of vocational training, and often must have passed a licensing exam, in order to perform the job. |
| Job Training |
Employees in these occupations usually need one or two years of training involving both on-the-job experience and informal training with experienced workers. |
| Job Zone Examples |
These occupations usually involve using communication and organizational skills to coordinate, supervise, manage, or train others to accomplish goals. Examples include funeral directors, electricians, forest and conservation technicians, legal secretaries, interviewers, and insurance sales agents. |
| SVP Range |
(6.0 to < 7.0) |
| Education |
Most occupations in this zone require training in vocational schools, related on-the-job experience, or an associate's degree. Some may require a bachelor's degree. |
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Interests
Interest code: CE
| Conventional — Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow. |
| Enterprising — Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business. |
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Work Styles
| Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations. |
| Attention to Detail — Job requires being careful about detail and thorough in completing work tasks. |
| Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace. |
| Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems. |
| Integrity — Job requires being honest and ethical. |
| Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude. |
| Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high stress situations. |
| Initiative — Job requires a willingness to take on responsibilities and challenges. |
| Self Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations. |
| Persistence — Job requires persistence in the face of obstacles. |
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Work Values
| Support — Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical. |
| Working Conditions — Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions. |
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Related Occupations
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Wages & Employment Trends
National
Median wages data collected from Claims Adjusters, Examiners, and Investigators.
Employment data collected from Claims Adjusters, Examiners, and Investigators.
| Median wages (2006) |
$24.36 hourly, $50,660 annual |
| Employment (2006) |
305,000 employees |
| Projected growth (2006-2016) |
Average (7% to 13%)
|
| Projected need (2006-2016) |
105,000 additional employees |
State & National
Source: Bureau of Labor Statistics 2006 wage data
and 2006-2016 employment projections
.
"Projected growth" represents the estimated change in total employment over the projections period (2006-2016). "Projected need" represents job openings due to growth and net replacement.
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