Claims Examiner

Updated: 11 March 2024

What Does Claims Examiner Mean?

Claims examiner refers to the person in the insurance company who reviews the claims settled by the insurance adjuster, files claims as entries for inventory, investigates dubious claims, writes reports on claims for the company, and participates in a litigation involving claims by consulting with the legal counsel.

Insuranceopedia Explains Claims Examiner

Claims flood an insurance company. Most of these are settled by a claims adjuster. All of the claims pass through the claims examiner. It is duty of the claims examiner to settle the claims in the best interest of the insurance company. That is the just one of the many assigned duties of a claims examiner.

The claims examiner must also notice any irregularities and must always be on the lookout for overspending and underspending where claims are concerned. When the claims examiner notices a questionable claim, they just don't just file a report. It is their job to investigate it. It can also mean consulting with other professionals. In a medical claim, for instance, the claims examiner would consult a medical doctor to help analyze the merit of a claim. When an insurance company wants to pursue a case against a policyholder, it does so after a recommendation by the claims examiner. In the litigation process, the legal counsel and the claim examiner work together on the case.

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