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Claims Examiners And Investigators Career

Career Description

Claims Examiners and Investigators work primarily for property and casualty insurance companies, for whom they handle a wide variety of claims alleging property damage, liability, or bodily injury. Their main role is to investigate the claims, negotiate settlements, and authorize payments to claimants, all the while mindful not to violate the claimant’s rights under Federal and State privacy laws. They must determine whether the customer’s insurance policy covers the loss and how much of the loss should be paid to the claimant. Although many examiners and investigators have overlapping functions and may even perform the same tasks, the insurance industry generally assigns specific roles to each of these claims workers.

Common Work Tasks

  • Review the claims submitted in order to ensure that proper guidelines have been followed
  • Assist adjusters with complex and complicated claims or when a disaster suddenly greatly increases the volume of claims
  • Review health-related claims to see whether costs are reasonable given the diagnosis
  • Use guides with information on the average period of disability, the expected treatments, and the average hospital stay for the various ailments
  • Check claim applications for completeness and accuracy, interview medical specialists, and consult policy files to verify the information reported in a claim
  • Use information gathered to evaluate a claim
  • Authorize the appropriate payment or refer the claim to an investigator for a more thorough review
  • Handle claims in which the company suspects fraudulent or criminal activity, such as arson, falsified workers’ disability claims, staged accidents, or unnecessary medical treatments
  • Search databases to obtain background information on claimants and witnesses
  • Access certain personal information and identify Social Security numbers, aliases, driver’s license numbers, addresses, phone numbers, criminal records, and past claims histories to establish whether a claimant has ever attempted insurance fraud

Other Job Titles

Claims Examiners and Investigators are also known by other titles, including:

  • Insurance Investigator
  • Auto Damage Appraiser
  • Cost Estimator
  • Auditor
  • Bill Collector
  • Public Adjuster

Education,  Training, and Experience

Education and Training
  There are no formal education requirements for either of these occupations, and a high school degree is typically the minimal requirement needed to obtain employment.  However, most employers prefer to hire college graduates or people who have some postsecondary training.

Certification and Licensure
      Licensing requirements for claims examiners and investigators vary by State. Some States have few requirements, while others require either the completion of pre-licensing education, a satisfactory score on a licensing exam, or both. Earning a voluntary professional designation can sometimes substitute for completing an exam.

Experience
          Claims examiners and investigators often work closely with claimants, witnesses, and other insurance professionals, so they must be able to communicate effectively with others. Knowledge of computer applications also is very helpful. In addition, a valid driver’s license and a good driving record are required for workers who must travel on the job. Some companies require applicants to pass a series of written aptitude tests designed to measure their communication,  analytical, and general mathematical skills.

Salary

The median annual salary of Claims Examiners and Investigators is $53,000. The top 10 percent earn more than $81,000 annually, and the bottom 10 percent earn less than $33,000 annually. Median earnings in the industries employing the largest number of claims examiners and investigators are:

  • Insurance Carriers - $54,910
  • Agencies, Brokerages, and Other Insurance Related Activities - $53,430
  • Federal Executive Branch - $63,200
  • State Government - $51,210
  • Management of Companies and Enterprises - $53,510

Job Outlook

  • 2006-2016 Employment growth:  9%
  • Number of new jobs created 2006-2016: 29,000
  • Employment 2006 : 319,000
  • Employment 2016:  347,000
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