Claims Examiner Job Description Template

The Claims Examiner will be responsible for reviewing and processing insurance claims. They will investigate the claim to determine if it is valid, and then work with the claimant to resolve the issue. The Claims Examiner will also work with other departments within the company to ensure that all claims are handled timely and efficiently.

Claims Examiner Job Responsibilities

  • Review insurance claims to determine coverage and liability
  • Investigate facts of each claim to determine validity
  • Evaluate claimants' damages to calculate compensation owed
  • Prepare reports detailing findings and recommendations
  • Work with attorneys, medical professionals, and others as needed to resolve claims
  • Keep upto-date on changes in relevant laws and regulations


  • To ensure that all claims are processed efficiently and accurately
  • To investigate and resolve any discrepancies in claims
  • To work closely with other departments to ensure timely and accurate processing of claims
  • To maintain up-to-date knowledge of policies and procedures related to claims processing
  • To provide excellent customer service to policyholders and claimants

Claims Examiner Job Skills & Qualifications Needed

  • Education: Claims examiners typically need at least a high school diploma, although some jobs may require postsecondary education, such as an associate degree in claims adjusting.
  • Skills: Claims examiners must have strong analytical and problemsolving skills to review insurance claims and determine whether they are valid. They also must be able to communicate effectively in writing and verbally to explain their decisions to claimants.