Claims Examiners, Property and Casualty Insurance

Career Description: 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.

Industry: Business and Financial Operations

Other Job Titles for Claims Examiners, Property and Casualty Insurance:

• 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.
• 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.
• 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.
• Social: Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
• 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.
• 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
• Second Interest High-Point: Secondary-Cutoff/Rank Descriptiveness
• Third Interest High-Point: Tertiary-Cutoff/Rank Descriptiveness

• 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.
• Confer with legal counsel on claims requiring litigation.
• Report overpayments, underpayments, and other irregularities.
• Communicate with reinsurance brokers to obtain information necessary for processing claims.
• Supervise claims adjusters to ensure that adjusters have followed proper methods.
• Conduct detailed bill reviews to implement sound litigation management and expense control.
• Prepare reports to be submitted to company's data processing department.
• Review taxpayer accounts, and conduct audits on-site, by correspondence, or by summoning taxpayer to office.
• Evaluate taxpayer finances to determine tax liability, using knowledge of interest and discount rates, annuities, valuation of stocks and bonds, and amortization valuation of depletable assets.
• Examine records, tax returns, and related documents pertaining to settlement of decedent's estate.
• Audit payroll and personnel records to determine unemployment insurance premiums, workers' compensation coverage, liabilities, and compliance with tax laws.

Emerging Tasks

• Supervise staff members.

• Analyzing Data or Information: Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
• Assisting and Caring for Others: Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.
• Coaching and Developing Others: Identifying the developmental needs of others and coaching, mentoring, or otherwise helping others to improve their knowledge or skills.
• 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.
• Communicating with Supervisors, Peers, or Subordinates: Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
• Controlling Machines and Processes: Using either control mechanisms or direct physical activity to operate machines or processes (not including computers or vehicles).
• Coordinating the Work and Activities of Others: Getting members of a group to work together to accomplish tasks.
• Developing and Building Teams: Encouraging and building mutual trust, respect, and cooperation among team members.
• Developing Objectives and Strategies: Establishing long-range objectives and specifying the strategies and actions to achieve them.
• Documenting/Recording Information: Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
• Drafting, Laying Out, and Specifying Technical Devices, Parts, and Equipment: Providing documentation, detailed instructions, drawings, or specifications to tell others about how devices, parts, equipment, or structures are to be fabricated, constructed, assembled, modified, maintained, or used.
• Establishing and Maintaining Interpersonal Relationships: Developing constructive and cooperative working relationships with others, and maintaining them over time.
• Estimating the Quantifiable Characteristics of Products, Events, or Information: Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.
• 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.
• Getting Information: Observing, receiving, and otherwise obtaining information from all relevant sources.
• Guiding, Directing, and Motivating Subordinates: Providing guidance and direction to subordinates, including setting performance standards and monitoring performance.
• Handling and Moving Objects: Using hands and arms in handling, installing, positioning, and moving materials, and manipulating things.
• Identifying Objects, Actions, and Events: Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
• Inspecting Equipment, Structures, or Material: Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.
• Interacting With Computers: Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
• Interpreting the Meaning of Information for Others: Translating or explaining what information means and how it can be used.
• Judging the Qualities of Things, Services, or People: Assessing the value, importance, or quality of things or people.
• Making Decisions and Solving Problems: Analyzing information and evaluating results to choose the best solution and solve problems.
• Monitor Processes, Materials, or Surroundings: Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
• Monitoring and Controlling Resources: Monitoring and controlling resources and overseeing the spending of money.
• Operating Vehicles, Mechanized Devices, or Equipment: Running, maneuvering, navigating, or driving vehicles or mechanized equipment, such as forklifts, passenger vehicles, aircraft, or water craft.
• Organizing, Planning, and Prioritizing Work: Developing specific goals and plans to prioritize, organize, and accomplish your work.
• Performing Administrative Activities: Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
• Performing for or Working Directly with the Public: Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.
• Performing General Physical Activities: Performing physical activities that require considerable use of your arms and legs and moving your whole body, such as climbing, lifting, balancing, walking, stooping, and handling of materials.
• Processing Information: Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
• Provide Consultation and Advice to Others: Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics.
• Repairing and Maintaining Electronic Equipment: Servicing, repairing, calibrating, regulating, fine-tuning, or testing machines, devices, and equipment that operate primarily on the basis of electrical or electronic (not mechanical) principles.
• Repairing and Maintaining Mechanical Equipment: Servicing, repairing, adjusting, and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical (not electronic) principles.
• Resolving Conflicts and Negotiating with Others: Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
• Scheduling Work and Activities: Scheduling events, programs, and activities, as well as the work of others.
• Selling or Influencing Others: Convincing others to buy merchandise/goods or to otherwise change their minds or actions.
• Staffing Organizational Units: Recruiting, interviewing, selecting, hiring, and promoting employees in an organization.
• Thinking Creatively: Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
• Training and Teaching Others: Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.
• Updating and Using Relevant Knowledge: Keeping up-to-date technically and applying new knowledge to your job.

Detailed Work Activities

• communicate technical information
• compile information through interviews
• confer with prosecuting attorney
• develop management control systems
• direct and coordinate activities of workers or staff
• examine documents for completeness, accuracy, or conformance to standards
• follow contract, property, or insurance laws
• investigate insurance claims
• maintain insurance records
• maintain records, reports, or files
• make presentations
• note discrepancies in financial records
• obtain information from individuals
• prepare reports
• recommend claim action
• review data on insurance applications or policies
• use computers to enter, access or retrieve data
• use interviewing procedures
• use knowledge of investigation techniques
• verify investigative information
• use accounting or bookkeeping software
• use accounting terminology
• use computers to enter, access and retrieve financial data
• use cost benefit analysis techniques
• use spreadsheet software
• verify bank or financial transactions
• write administrative procedures services manual
• write business correspondence
• use interviewing procedures
• use marketing techniques
• use negotiation techniques
• use accounting terminology
• use computers to enter, access and retrieve financial data
• use cost benefit analysis techniques
• use spreadsheet software
• use statistical cost estimation methods
• verify bank or financial transactions
• write administrative procedures services manual

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.

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.

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.

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• Projected growth (2006-2016): 8.93%
• Projected need (2006-2016): 27,250
• Employment (2006): 305,169

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