Claims Examiner

Updated: 16 November 2024

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.

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.

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