Claims Examiner Job Description Template

The Claims Examiner job description template outlines the responsibilities and requirements for a professional who evaluates insurance claims to determine their validity and payout. This job position requires a keen eye for detail, strong communication skills, and knowledge of insurance policies and regulations. It is essential for insurance companies to hire competent Claims Examiners who can efficiently process claims and maintain accurate records. This template can be used by companies looking to attract qualified candidates for their Claims Examiner position.

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Job Overview

As a Claims Examiner, you will be responsible for reviewing insurance claims and ensuring they are in compliance with company policies and industry regulations. You will be required to analyze claims data, investigate claims, negotiate settlements, and provide exceptional customer service to policyholders.

Key Responsibilities

  • Review insurance claims to determine validity and severity of loss
  • Verify policy coverage and investigate claimant eligibility
  • Gather and analyze claims data to identify fraudulent activity and mitigate risk
  • Negotiate claim settlements and authorize payments
  • Provide excellent customer service and maintain positive relationships with policyholders, agents, and internal stakeholders
  • Collaborate with legal and compliance teams to ensure claims compliance with industry regulations and company policies
  • Maintain accurate claims records and documentation


  • Bachelor’s degree in Business Administration, Accounting or related field preferred
  • Minimum of 2 years’ experience in insurance claims or related field
  • Strong analytical and problem-solving skills
  • Excellent communication and negotiation skills
  • Knowledge of insurance policies, coverage, and regulations
  • Proficient in Microsoft Office and claims management software
  • Ability to work in a fast-paced environment and handle a large volume of claims

Working Conditions

  • Office-based work environment
  • May be required to work overtime or on weekends as needed
  • May be required to travel occasionally for training or conferences


Creating a job posting is a critical step in the process of hiring the right candidate for your organization. A well-crafted job posting can attract the right talent, improve the quality of the applicants and reduce the cost of turnover.

Job Title and Summary

The first step in creating a job posting for a Claims Examiner is to define the job title and summary. The job title should be clearly defined and reflect the responsibilities of the position. The summary should provide a brief overview of the job, its purpose, and the qualifications of the applicant.

  • Job Title: Claims Examiner
  • Summary: The Claims Examiner will be responsible for reviewing and analyzing claims, investigating discrepancies, and resolving issues in a timely manner. The candidate should have strong analytical skills, attention to detail, and exceptional customer service abilities.
  • Job Responsibilities

    The next step is to outline the responsibilities of the Claims Examiner position. These responsibilities should be clearly defined and reflect the key duties and functions of the job.

  • Review and analyze claims, ensuring accuracy and completeness.
  • Investigate discrepancies, errors, or issues related to claims.
  • Determine the appropriate course of action to resolve issues and ensure payment of claims.
  • Communicate with clients, providers, and internal teams to address concerns and provide updates on claims.
  • Maintain accurate records and documentation related to claims processing.
  • Qualifications and Requirements

    The qualifications and requirements section outlines the education, experience, and skills required to be successful in the Claims Examiner role.

  • Bachelor's degree in a related field or equivalent work experience.
  • 2+ years of experience in claims processing, adjudication, or related field preferred.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Ability to work in a fast-paced environment.
  • Benefits and Perks

    The benefits and perks section of the job posting provides information on what the candidate can expect in terms of compensation and benefits.

  • Competitive salary
  • Health, dental, and vision insurance
  • 401(k) plan with employer match
  • Paid time off and holidays
  • Tuition reimbursement program
  • Conclusion

    Creating a job posting for a Claims Examiner should be approached with care and attention to detail. A well-crafted job posting can attract qualified candidates and help ensure the best hire for your organization. Follow the steps outlined above to create a job posting that highlights the key responsibilities, qualifications, and benefits of the Claims Examiner role.

    What is a Claims Examiner?

    A Claims Examiner is a professional who investigates and evaluates insurance claims to determine their legitimacy and make recommendations for settlements. They work for insurance companies, and their primary responsibility is to ensure that claims are processed accurately and quickly. They are also responsible for investigating claims that may be fraudulent.

    What are the qualifications required for a Claims Examiner?

    To become a Claims Examiner, a person must have a high school diploma or its equivalent. However, many employers prefer to hire people who have at least an associate's degree in fields such as business, accounting, or finance. Additionally, experience in the insurance industry is a plus. The ideal candidate for the Claims Examiner position should have excellent communication and organizational skills, the ability to work well under pressure and handle a large volume of workloads, and high attention to detail.

    What are the responsibilities of a Claims Examiner?

  • - Investigating claims to verify legitimacy and determine coverage
  • - Evaluate claims and make recommendations for settlement
  • - Negotiating and settling claims with claimants and attorneys
  • - Reviewing and analyzing medical records, police reports, witness statements, and other documents to support or dispute claims
  • - Investigating and identifying potential fraudulent claims
  • What should be included in a Claims Examiner job posting?

    A Claims Examiner job posting should include the following information:

  • - A clear job title that accurately reflects the position
  • - A summary of the job responsibilities and qualifications required
  • - The location of the job
  • - The salary range or hourly rate
  • - Information on benefits, such as health insurance, 401k, vacation, and sick leave
  • - The job schedule and any specific work requirements, such as weekend or evening hours
  • - Information on how to apply for the job, including the closing date for applications
  • What are some tips for creating a compelling Claims Examiner job posting?

  • - Use clear language and avoid jargon or technical terms that may not be familiar to everyone
  • - Highlight the unique features of your organization, such as your company culture or mission statement
  • - Be specific about the job requirements, but also be open to candidates from different backgrounds who may have transferable skills
  • - Include information on career growth opportunities and ongoing professional development
  • - Describe any perks or benefits that make your company an attractive place to work
  • - Use bullet points and subheadings to break up large blocks of text and make the job posting easier to read
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