Claims Examiner

A Claims Examiner evaluates, analyzes, and adjudicates insurance claims to determine coverage, liability, and appropriate settlement amounts. Examiners typically handle claims from a desk environment and focus on accuracy, compliance, and documentation rather than field inspections. They ensure claims are resolved fairly, efficiently, and in accordance with policy language and regulatory standards.

Core Responsibilities

• Review claim submissions, statements, and supporting documentation
• Verify coverage and apply policy terms, conditions, and exclusions
• Assess liability and damages based on evidence and applicable laws
• Request additional information from policyholders, claimants, or providers
• Negotiate settlements within authority limits
• Identify potential fraud indicators and escalate when appropriate
• Maintain accurate claim files and ensure regulatory compliance

Key Skills

• Analytical thinking and attention to detail
• Strong written communication
• Knowledge of insurance policies and claims workflows
• Negotiation and conflict resolution
• Time management and organization

Common Designations

• AIC — Associate in Claims
• AINS — Associate in General Insurance
• SCLA — Senior Claim Law Associate