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How Do I Become a Claims Examiner?

Meghan Perry
Meghan Perry

The requirements to become a claims examiner may vary quite drastically among states in the U.S. At minimum, a high school education is required, but it has become more common for companies to want examiners to have associate's or bachelor's degrees. There isn't a major specific to this line of work, but a degree in a business-related field is useful. Work experience and other skills may also be requirements. In addition, some states require that insurance claims examiners be licensed or certified, so that may be another step to become a claims examiner.

In general, claims examiners review claims made by insurance policyholders. One of the reasons for this is to make sure that the correct guidelines and regulations have been followed; another is to ensure that the claim isn't fraudulent. Reviewing claims requires an attention to detail, so possessing that quality will help one become a claims examiner. As the examiner also must often follow up with the policyholder and have to interview other people regarding the claim, strong communication skills are also useful. Finally, as claims examiners often work on many claims at one time, organization and time management skills may also be essential to become a claims examiner.

Claims examiners review insurance claims.
Claims examiners review insurance claims.

Increasingly common are companies that hire claims examiners with college degrees, either associate's or bachelor's degrees. Besides a business-related degree, another option is to major in a field that will be relevant to the area of insurance in which the examiner is working. For example, claims examiners working in the health insurance field may be helped by a degree in health care or medicine, and an engineering degree may be useful for someone who wishes to work in property insurance. Specific courses that may be helpful to take in college include business, law, economics, and math courses. Knowledge of computer software has also become more necessary.

Some states require that insurance claims examiners be licensed before they can work in the state. This may include specific insurance-related training or course work, as well as a written examination, to demonstrate knowledge of the regulations related to the insurance industry. Often, licenses and certifications are only valid for a specific number of years, at which time renewal would be required. Many insurance companies offer continuing education training in the form of workshops and seminars to keep employees current on any legal or regulatory changes.

Once the education and licensing portions to become a claims examiner are completed, the next step is to get a job. Many claims examiners begin as junior examiners, trainees, or apprentices and work under the direct supervision of a more experienced examiner. As the trainee gains more experience, he or she will work on more complex cases until the employee moves into the role of claims examiner.

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    • Claims examiners review insurance claims.
      By: emiliezhang
      Claims examiners review insurance claims.