Skip navigation

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 Adjuster, Claims Analyst, Claims Examiner, Claims Manager, Claims Representative, Claims Specialist, Claims Supervisor, Corporate Claims Examiner, Customer Care Specialist, Home Office Claim Specialist

View report: Summary  Details  Custom

Tasks  |  Tools & Technology  |  Knowledge  |  Skills  |  Abilities  |  Work Activities  |  Detailed Work Activities  |  Work Context  |  Job Zone  |  Education  |  Credentials  |  Interests  |  Work Styles  |  Work Values  |  Related Occupations  |  Wages & Employment  |  Job Openings  |  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. See more occupations related to this task.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. See more occupations related to this task.
  • Resolve complex, severe exposure claims, using high service oriented file handling. See more occupations related to this task.
  • Pay and process claims within designated authority level. See more occupations related to this task.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. See more occupations related to this task.
  • 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. See more occupations related to this task.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. See more occupations related to this task.
  • Confer with legal counsel on claims requiring litigation. See more occupations related to this task.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information. See more occupations related to this task.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. See more occupations related to this task.
  • Present cases and participate in their discussion at claim committee meetings. See more occupations related to this task.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods. See more occupations related to this task.
  • Conduct detailed bill reviews to implement sound litigation management and expense control. See more occupations related to this task.
  • Report overpayments, underpayments, and other irregularities. See more occupations related to this task.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims. See more occupations related to this task.
  • Prepare reports to be submitted to company's data processing department. See more occupations related to this task.

Find occupations related to multiple tasks

back to top

Tools & Technology

Tools used in this occupation:

  • Desktop computers See more occupations related to this tool.
  • Notebook computers See more occupations related to this tool.
  • Personal computers See more occupations related to this tool.
  • Personal digital assistant PDAs or organizers — Personal digital assistants PDA See more occupations related to this tool.
  • Scanners See more occupations related to this tool.
  • Tablet computers See more occupations related to this tool.

Technology used in this occupation:

  • Access software — CCC EZNet electronic communications network; CSC Automated Work Distributor AWD See more occupations related to this technology.
  • Analytical or scientific software — Insurance claims fraud detection software; Magnify Predictive Targeting System See more occupations related to this technology.
  • Data base reporting software — Corporate Systems ClaimsPro See more occupations related to this technology.
  • Data base user interface and query software — Claims processing administration and management software; Fair Isaac Claims Advisor; Tropics Claims Reserve Management See more occupations related to this technology.
  • Document management software — Agency Management Systems AMS 360; BCCORP W5 for Adjusters; Document management system software; InSystems Calligo Document Management System (see all 19 examples) See more occupations related to this technology.
  • Enterprise resource planning ERP software — CCC Pathways Appraisal Quality Solution See more occupations related to this technology.
  • Expert system software — Axonwave Fraud and Abuse Management System; Bill review software; LexisNexis RiskWise; StrataCare StrataWare eReview (see all 12 examples) See more occupations related to this technology.
  • Interactive voice response software — Computerized voice stress analyzer CVSA software See more occupations related to this technology.
  • Office suite software — Microsoft Office software See more occupations related to this technology.
  • Presentation software — Microsoft PowerPoint See more occupations related to this technology.
  • Spreadsheet software — Microsoft Excel See more occupations related to this technology.
  • Word processing software — Microsoft Word See more occupations related to this technology.

back to top

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. See more occupations related to this knowledge.
  • English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. See more occupations related to this knowledge.
  • Law and Government — Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process. See more occupations related to this knowledge.
  • 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. See more occupations related to this knowledge.

back to top

Skills

  • Reading Comprehension — Understanding written sentences and paragraphs in work related documents. See more occupations related to this skill.
  • Writing — Communicating effectively in writing as appropriate for the needs of the audience. See more occupations related to this skill.
  • 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. See more occupations related to this skill.
  • Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. See more occupations related to this skill.
  • Speaking — Talking to others to convey information effectively. See more occupations related to this skill.
  • Negotiation — Bringing others together and trying to reconcile differences. See more occupations related to this skill.
  • Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one. See more occupations related to this skill.
  • Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. See more occupations related to this skill.
  • Monitoring — Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action. See more occupations related to this skill.
  • Social Perceptiveness — Being aware of others' reactions and understanding why they react as they do. See more occupations related to this skill.
  • Active Learning — Understanding the implications of new information for both current and future problem-solving and decision-making. See more occupations related to this skill.
  • Coordination — Adjusting actions in relation to others' actions. See more occupations related to this skill.
  • Service Orientation — Actively looking for ways to help people. See more occupations related to this skill.
  • Persuasion — Persuading others to change their minds or behavior. See more occupations related to this skill.
  • Time Management — Managing one's own time and the time of others. See more occupations related to this skill.

back to top

Abilities

  • Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences. See more occupations related to this ability.
  • Written Comprehension — The ability to read and understand information and ideas presented in writing. See more occupations related to this ability.
  • Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense. See more occupations related to this ability.
  • Oral Expression — The ability to communicate information and ideas in speaking so others will understand. See more occupations related to this ability.
  • 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. See more occupations related to this ability.
  • Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events). See more occupations related to this ability.
  • Speech Clarity — The ability to speak clearly so others can understand you. See more occupations related to this ability.
  • Speech Recognition — The ability to identify and understand the speech of another person. See more occupations related to this ability.
  • Written Expression — The ability to communicate information and ideas in writing so others will understand. See more occupations related to this ability.
  • 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). See more occupations related to this ability.
  • Near Vision — The ability to see details at close range (within a few feet of the observer). See more occupations related to this ability.
  • Category Flexibility — The ability to generate or use different sets of rules for combining or grouping things in different ways. See more occupations related to this ability.
  • Mathematical Reasoning — The ability to choose the right mathematical methods or formulas to solve a problem. See more occupations related to this ability.
  • Selective Attention — The ability to concentrate on a task over a period of time without being distracted. See more occupations related to this ability.

back to top

Work Activities

  • Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources. See more occupations related to this activity.
  • Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information. See more occupations related to this activity.
  • Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others. See more occupations related to this activity.
  • Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person. See more occupations related to this activity.
  • 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. See more occupations related to this activity.
  • Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events. See more occupations related to this activity.
  • Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems. See more occupations related to this activity.
  • Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data. See more occupations related to this activity.
  • Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form. See more occupations related to this activity.
  • Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work. See more occupations related to this activity.
  • Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail. See more occupations related to this activity.
  • Monitor Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems. See more occupations related to this activity.
  • Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job. See more occupations related to this activity.
  • Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time. See more occupations related to this activity.
  • Analyzing Data or Information — Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts. See more occupations related to this activity.
  • Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used. See more occupations related to this activity.
  • Performing for or Working Directly with the Public — Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests. See more occupations related to this activity.
  • Judging the Qualities of Things, Services, or People — Assessing the value, importance, or quality of things or people. See more occupations related to this activity.
  • Thinking Creatively — Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions. See more occupations related to this activity.
  • Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork. See more occupations related to this activity.
  • Developing Objectives and Strategies — Establishing long-range objectives and specifying the strategies and actions to achieve them. See more occupations related to this activity.
  • Estimating the Quantifiable Characteristics of Products, Events, or Information — Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity. See more occupations related to this activity.
  • Inspecting Equipment, Structures, or Material — Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects. See more occupations related to this activity.
  • Monitoring and Controlling Resources — Monitoring and controlling resources and overseeing the spending of money. See more occupations related to this activity.

back to top

Detailed Work Activities

  • Supervise employees. See more occupations related to this activity.
  • Pay charges, fees, or taxes. See more occupations related to this activity.
  • Prepare operational reports. See more occupations related to this activity.
  • Interview witnesses, suspects, or claimants. See more occupations related to this activity.
  • Examine financial records. See more occupations related to this activity.
  • Investigate legal issues. See more occupations related to this activity.
  • Implement financial decisions. See more occupations related to this activity.
  • Negotiate agreements to resolve disputes. See more occupations related to this activity.
  • Advise others on financial matters. See more occupations related to this activity.
  • Verify accuracy of records. See more occupations related to this activity.
  • Maintain data in information systems or databases. See more occupations related to this activity.
  • Confer with others about financial matters. See more occupations related to this activity.
  • Prepare financial documents. See more occupations related to this activity.
  • Report information to managers or other personnel. See more occupations related to this activity.
  • Present business-related information to audiences. See more occupations related to this activity.

Find occupations related to multiple detailed work activities

back to top

Work Context

  • Electronic Mail — 99% responded “Every day.” See more occupations related to this work context.
  • Telephone — 100% responded “Every day.” See more occupations related to this work context.
  • Letters and Memos — 95% responded “Every day.” See more occupations related to this work context.
  • Importance of Being Exact or Accurate — 80% responded “Extremely important.” See more occupations related to this work context.
  • Contact With Others — 75% responded “Constant contact with others.” See more occupations related to this work context.
  • Frequency of Decision Making — 75% responded “Every day.” See more occupations related to this work context.
  • Impact of Decisions on Co-workers or Company Results — 71% responded “Very important results.” See more occupations related to this work context.
  • Duration of Typical Work Week — 86% responded “More than 40 hours.” See more occupations related to this work context.
  • Indoors, Environmentally Controlled — 88% responded “Every day.” See more occupations related to this work context.
  • Spend Time Sitting — 62% responded “Continually or almost continually.” See more occupations related to this work context.
  • Face-to-Face Discussions — 61% responded “Every day.” See more occupations related to this work context.
  • Frequency of Conflict Situations — 67% responded “Every day.” See more occupations related to this work context.
  • Work With Work Group or Team — 57% responded “Extremely important.” See more occupations related to this work context.
  • Deal With External Customers — 70% responded “Extremely important.” See more occupations related to this work context.
  • Freedom to Make Decisions — 37% responded “A lot of freedom.” See more occupations related to this work context.
  • Importance of Repeating Same Tasks — 56% responded “Very important.” See more occupations related to this work context.
  • Spend Time Making Repetitive Motions — 59% responded “Continually or almost continually.” See more occupations related to this work context.
  • Time Pressure — 18% responded “Once a week or more but not every day.” See more occupations related to this work context.
  • Degree of Automation — 48% responded “Highly automated.” See more occupations related to this work context.
  • Level of Competition — 44% responded “Extremely competitive.” See more occupations related to this work context.
  • Structured versus Unstructured Work — 41% responded “A lot of freedom.” See more occupations related to this work context.
  • Coordinate or Lead Others — 40% responded “Extremely important.” See more occupations related to this work context.
  • Sounds, Noise Levels Are Distracting or Uncomfortable — 29% responded “Every day.” See more occupations related to this work context.
  • Deal With Unpleasant or Angry People See more occupations related to this work context.
  • Physical Proximity — 43% responded “Slightly close (e.g., shared office).” See more occupations related to this work context.
  • Responsibility for Outcomes and Results — 31% responded “High responsibility.” See more occupations related to this work context.

back to top

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, art directors, and cost estimators.
SVP Range (7.0 to < 8.0)

back to top

Education


Percentage of Respondents
Education Level Required
69   Bachelor's degree
12   High school diploma or equivalent Help
8   Some college, no degree

back to top

Credentials

Find Training Find Certifications Find Licenses

back to top

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. See more occupations related to this interest.
  • 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. See more occupations related to this interest.

back to top

Work Styles

  • Integrity — Job requires being honest and ethical. See more occupations related to this work style.
  • Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations. See more occupations related to this work style.
  • Attention to Detail — Job requires being careful about detail and thorough in completing work tasks. See more occupations related to this work style.
  • Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high stress situations. See more occupations related to this work style.
  • Self Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations. See more occupations related to this work style.
  • Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude. See more occupations related to this work style.
  • 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. See more occupations related to this work style.
  • Persistence — Job requires persistence in the face of obstacles. See more occupations related to this work style.
  • Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace. See more occupations related to this work style.
  • Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems. See more occupations related to this work style.
  • Initiative — Job requires a willingness to take on responsibilities and challenges. See more occupations related to this work style.
  • Achievement/Effort — Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks. See more occupations related to this work style.
  • Concern for Others — Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job. See more occupations related to this work style.
  • Leadership — Job requires a willingness to lead, take charge, and offer opinions and direction. See more occupations related to this work style.
  • Innovation — Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems. See more occupations related to this work style.
  • Social Orientation — Job requires preferring to work with others rather than alone, and being personally connected with others on the job. See more occupations related to this work style.

back to top

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. See more occupations related to this work value.
  • 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. See more occupations related to this work value.
  • 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. See more occupations related to this work value.

back to top

Related Occupations

back to top

Wages & Employment Trends

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 (2014) $29.91 hourly, $62,220 annual
State wages Local Salary Info
 
Employment (2012) 298,000 employees
Projected growth (2012-2022) Slower than average (3% to 7%) Slower than average (3% to 7%)
Projected job openings (2012-2022) 80,300
State trends Employment Trends
 
Top industries (2012)

Source: Bureau of Labor Statistics 2014 wage data external site and 2012-2022 employment projections external site. "Projected growth" represents the estimated change in total employment over the projections period (2012-2022). "Projected job openings" represent openings due to growth and replacement.

back to top

Job Openings on the Web

Find Jobs Job Banks

back to top

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.

back to top