Claims Examiner

What Does Claims Examiner Mean?

A claims examiner is the person within an insurance company who reviews claims settled by the insurance adjuster, records claims as inventory entries, investigates suspicious claims, writes reports on claims for the company, and participates in litigation related to claims by consulting with legal counsel.

Insuranceopedia Explains Claims Examiner

Insurance companies receive a high volume of claims, most of which are settled by claims adjusters. However, all claims pass through the claims examiner. It is the claims examiner’s responsibility to ensure claims are settled in the best interest of the insurance company, which is just one of their many duties. From a policyholder’s side, this is part of why claims service shows up in comparisons of the best car insurance companies, since how an insurer’s internal review treats borderline cases affects what a customer ends up being paid.

The claims examiner must also be vigilant in identifying irregularities, looking out for both overspending and underspending in claims. When a questionable claim is noticed, it is not enough to simply file a report—it is the claims examiner’s job to investigate further. This may involve consulting with other professionals. For example, in a medical claim, the claims examiner would consult a medical doctor to help assess the validity of the claim. If an insurance company decides to pursue legal action against a policyholder, this typically follows a recommendation from the claims examiner. During the litigation process, the claims examiner works closely with legal counsel on the case. For property damage in particular, claims handling can vary a lot between insurers, and looking at how the best homeowners insurance companies deal with payouts is one way to set expectations before you file.