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 Specialist, Claims Adjuster, Claims Representative, Claims Analyst, Claims Manager, Claims Supervisor, Customer Care Specialist, Corporate Claims Examiner, Home Office Claim Specialist
Tasks | Tools & Technology | Knowledge | Skills | Abilities | Work Activities | Work Context | Job Zone | Education | Interests | Work Styles | Work Values | Related Occupations | Wages & Employment | Additional Information
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.
- 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.
- 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.
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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 |
| Scanners |
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
| 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. |
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Skills
| Reading Comprehension — Understanding written sentences and paragraphs in work related documents. |
| Writing — Communicating effectively in writing as appropriate for the needs of the audience. |
| 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. |
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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. |
| Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense. |
| Oral Expression — The ability to communicate information and ideas in speaking so others will understand. |
| 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. |
| Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events). |
| 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. |
| Written Expression — The ability to communicate information and ideas in writing so others will understand. |
| 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). |
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Work Activities
| Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources. |
| Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information. |
| Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others. |
| Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person. |
| 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. |
| Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events. |
| 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. |
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Work Context
| Electronic Mail — How often do you use electronic mail in this job? |
| Telephone — How often do you have telephone conversations in this job? |
| Letters and Memos — How often does the job require written letters and memos? |
| 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? |
| 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? |
| Impact of Decisions on Co-workers or Company Results — How do the decisions an employee makes impact the results of co-workers, clients or the company? |
| Duration of Typical Work Week — Number of hours typically worked in one week. |
| 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? |
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Job Zone
| Title |
Job Zone Four: Considerable Preparation Needed |
| Education |
Most of these occupations require a four-year bachelor's degree, but some do not. |
| Related Experience |
A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified. |
| Job Training |
Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training. |
| Job Zone Examples |
Many of these occupations involve coordinating, supervising, managing, or training others. Examples include accountants, sales managers, database administrators, teachers, chemists, environmental engineers, criminal investigators, and special agents. |
| SVP Range |
(7.0 to < 8.0) |
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Education
Percentage of Respondents |
Education Level Required |
69   |
Bachelor's degree |
| 14 |
Some college, no degree |
| 12 |
High school diploma or equivalent |
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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
| 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. |
| 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. |
| Persistence — Job requires persistence in the face of obstacles. |
| 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. |
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Work Values
| Independence — Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy. |
| 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.
Industry data collected from Claims Adjusters, Examiners, and Investigators.
| Median wages (2011) |
$28.52 hourly, $59,320 annual |
| Employment (2010) |
280,000 employees |
| Projected growth (2010-2020) |
Slower than average (3% to 9%)
|
| Projected job openings (2010-2020) |
79,900 |
| Top industries (2010) |
|
State & National
Source: Bureau of Labor Statistics 2011 wage data
and 2010-2020 employment projections
.
"Projected growth" represents the estimated change in total employment over the projections period (2010-2020). "Projected job openings" represent openings due to growth and replacement.
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Sources of Additional Information
Disclaimer:
Sources are listed to provide additional information on related jobs, specialties, and/or industries.
Links to non-DOL Internet sites are provided for your convenience and do not constitute an endorsement.
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Bright Outlook