Claims Examiners, Property and Casualty Insurance

What they do:

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.

On the job, you would:

  • 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.

Knowledge

  • 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.
  • English Language
  • Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • Law and Government
  • Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
  • Administration and Management
  • Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
  • 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.
  • Building and Construction
  • Knowledge of materials, methods, and the tools involved in the construction or repair of houses, buildings, or other structures such as highways and roads.
  • Psychology
  • Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
  • Education and Training
  • Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.

Skills

  • Writing
  • Communicating effectively in writing as appropriate for the needs of the audience.
  • Reading Comprehension
  • Understanding written sentences and paragraphs in work related documents.
  • 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.
  • 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.
  • Negotiation
  • Bringing others together and trying to reconcile differences.
  • Judgment and Decision Making
  • Considering the relative costs and benefits of potential actions to choose the most appropriate one.
  • Complex Problem Solving
  • Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
  • Monitoring
  • Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Social Perceptiveness
  • Being aware of others' reactions and understanding why they react as they do.

Abilities

  • Oral Comprehension
  • The ability to listen to and understand information and ideas presented through spoken words and sentences.
  • Written Comprehension
  • The ability to read and understand information and ideas presented in writing.
  • Oral Expression
  • The ability to communicate information and ideas in speaking so others will understand.
  • Deductive Reasoning
  • The ability to apply general rules to specific problems to produce answers that make sense.
  • 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 Expression
  • The ability to communicate information and ideas in writing 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).
  • Speech Recognition
  • The ability to identify and understand the speech of another person.
  • Speech Clarity
  • The ability to speak clearly so others can understand you.
  • Near Vision
  • The ability to see details at close range (within a few feet of the observer).

Work Activities

  • Getting Information
  • Observing, receiving, and otherwise obtaining information from all relevant sources.
  • Resolving Conflicts and Negotiating with Others
  • Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
  • Interacting With Computers
  • Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
  • Communicating with Supervisors, Peers, or Subordinates
  • Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
  • Identifying Objects, Actions, and Events
  • Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
  • 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.
  • Making Decisions and Solving Problems
  • Analyzing information and evaluating results to choose the best solution and solve problems.
  • Processing Information
  • Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
  • Documenting/Recording Information
  • Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
  • Organizing, Planning, and Prioritizing Work
  • Developing specific goals and plans to prioritize, organize, and accomplish your work.

Interests

  • 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.
  • First Interest High-Point
  • Primary-Rank Descriptiveness
  • 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.
  • Second Interest High-Point
  • Secondary-Cutoff/Rank Descriptiveness
  • Investigative
  • Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
  • Realistic
  • Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
  • Social
  • Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
  • Artistic
  • Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.
  • Third Interest High-Point
  • Tertiary-Cutoff/Rank Descriptiveness

Work Styles

  • Integrity
  • Job requires being honest and ethical.
  • 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.
  • Stress Tolerance
  • Job requires accepting criticism and dealing calmly and effectively with high stress situations.
  • Self Control
  • Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
  • Cooperation
  • Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
  • Persistence
  • Job requires persistence in the face of obstacles.
  • Independence
  • Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
  • Analytical Thinking
  • Job requires analyzing information and using logic to address work-related issues and problems.
  • Adaptability/Flexibility
  • Job requires being open to change (positive or negative) and to considerable variety in the workplace.