Claims Examiners, Property and Casualty Insurance

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.

Supervise claims adjusters to ensure that adjusters have followed proper methods.

Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

Resolve complex, severe exposure claims, using high service oriented file handling.

Pay and process claims within designated authority level.

Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

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.

Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

Confer with legal counsel on claims requiring litigation.

Conduct detailed bill reviews to implement sound litigation management and expense control.

Contact or interview claimants, doctors, medical specialists, or employers to get additional information.

Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.

Report overpayments, underpayments, and other irregularities.

Present cases and participate in their discussion at claim committee meetings.

Communicate with reinsurance brokers to obtain information necessary for processing claims.

Prepare reports to be submitted to company's data processing department.

Attend mediations or trials.