8 Property and Casualty Insurance Claims Examiner Job Description Templates and Examples

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a detail-oriented Junior Claims Examiner to join our dynamic team at [$COMPANY_NAME]. This entry-level position is crucial in ensuring the accuracy and efficiency of claims processing, providing a vital support role to our claims department.

Responsibilities

• Assist in the evaluation and analysis of claims submitted by policyholders to determine eligibility and coverage
• Review and verify documentation to ensure compliance with company policies and procedures
• Collaborate with senior examiners to identify discrepancies and recommend resolutions
• Maintain accurate records of claims processed and communicate updates to relevant stakeholders
• Provide exceptional customer service by answering inquiries and assisting claimants throughout the process
• Participate in training sessions to improve knowledge of claims procedures and industry regulations

Required and Preferred Qualifications

Required:

• Bachelor's degree or equivalent experience in a related field
• Strong analytical skills with attention to detail
• Effective communication skills, both verbal and written
• Ability to work independently and manage time effectively

Preferred:

• Experience in the insurance industry or a background in claims processing
• Familiarity with insurance policies and coverage types

Technical Skills and Relevant Technologies

• Proficiency in Microsoft Office Suite, particularly Excel for data management
• Experience with claims management software is a plus
• Basic understanding of legal and regulatory guidelines related to claims processing

Soft Skills and Cultural Fit

• Strong problem-solving abilities and a proactive approach to tasks
• Ability to thrive in a fast-paced, remote work environment
• Team-oriented mindset with a willingness to learn from experienced colleagues
• Adaptability to changing priorities and processes

Benefits and Perks

We offer a competitive salary and benefits package that includes:

• Health, dental, and vision insurance
• Retirement plan with company match
• Generous paid time off and holiday schedule
• Opportunities for professional development and training

Equal Opportunity Statement

[$COMPANY_NAME] is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other basis protected by applicable law.

Location

This is a fully remote position.

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a detail-oriented Claims Examiner to join our dynamic team at [$COMPANY_NAME]. In this role, you will be responsible for reviewing, analyzing, and processing insurance claims while ensuring compliance with company policies and regulatory requirements. You will play a critical role in delivering exceptional service to our clients and ensuring the integrity of our claims operations.

Responsibilities

• Review and evaluate insurance claims submitted by policyholders to determine validity and adherence to policy guidelines
• Analyze claim documentation, including medical records, accident reports, and witness statements, to assess the extent of liability
• Communicate with claimants, policyholders, and external stakeholders to gather necessary information and clarify any discrepancies
• Make informed decisions regarding claim approvals or denials, documenting rationale in accordance with company standards
• Collaborate with legal, underwriting, and medical professionals to ensure comprehensive claim evaluations
• Maintain accurate records of claims, ensuring compliance with regulatory requirements and internal policies
• Provide training and mentorship to junior claims staff, promoting best practices within the team

Required and Preferred Qualifications

Required:

• Bachelor's degree in a relevant field or equivalent experience
• 3+ years of experience as a Claims Examiner or similar role within the insurance industry
• Strong knowledge of insurance policies, procedures, and relevant regulations
• Excellent analytical and problem-solving skills, with a keen attention to detail
• Proficient in claims management systems and Microsoft Office Suite

Preferred:

• Professional certification in claims handling (e.g., AIC, CPCU) is a plus
• Experience in a specialized claims area (e.g., health, auto, property) is advantageous

Technical Skills and Relevant Technologies

• Proficient in using claims management software and database systems
• Familiarity with data analysis tools to identify trends and insights within claims data
• Ability to leverage technology to streamline claims processing and enhance efficiency

Soft Skills and Cultural Fit

• Exceptional verbal and written communication skills, with a strong customer service orientation
• Ability to work collaboratively in a fast-paced, team-oriented environment
• Strong organizational skills, capable of managing multiple claims concurrently
• Proactive mindset with a commitment to continuous improvement

Benefits and Perks

Salary: [$SALARY_RANGE]

Additional benefits may include:

• Comprehensive health insurance plans
• 401(k) retirement plan with company match
• Paid time off and holidays
• Professional development opportunities

Equal Opportunity Statement

[$COMPANY_NAME] is committed to fostering a diverse and inclusive workplace. We encourage applications from all qualified candidates, regardless of race, ethnicity, gender, age, sexual orientation, disability, or any other characteristic protected by law.

Location

This role requires successful candidates to be based in-person at our office located in [$COMPANY_LOCATION].

We encourage all candidates to apply, even if you don’t meet every requirement listed. Your unique experiences and perspectives are valuable to us!

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a highly skilled Senior Claims Examiner to join our dynamic team at [$COMPANY_NAME]. In this role, you will leverage your extensive knowledge of claims processing to ensure the accuracy and integrity of claims submissions while providing top-notch support to our customers and stakeholders. As a Senior Claims Examiner, you'll play a crucial role in enhancing our claims management processes, driving efficiency, and ensuring compliance with industry regulations.

Responsibilities

• Review, analyze, and adjudicate complex claims to determine eligibility, coverage, and appropriate payment amounts
• Collaborate with cross-functional teams to ensure timely and accurate claims processing
• Develop and implement best practices for claims processing and dispute resolution
• Provide mentorship and training to junior claims examiners to enhance team capabilities
• Conduct thorough investigations and audits of claims to identify potential fraud and discrepancies
• Prepare detailed reports and presentations on claims trends and metrics for management review

Required and Preferred Qualifications

Required:

• 5+ years of experience in claims examination or a related field within the insurance industry
• In-depth knowledge of claims regulations, processes, and industry standards
• Proven ability to analyze complex claims data and make informed decisions
• Strong attention to detail and exceptional organizational skills

Preferred:

• Bachelor's degree in Business, Finance, or a related field
• Professional certifications such as AIC, CPCU, or similar credentials
• Experience with claims management software and analytics tools

Technical Skills and Relevant Technologies

• Expertise in claims processing systems and claims adjudication software
• Proficient in data analysis tools and techniques to identify trends in claims
• Familiarity with regulatory compliance requirements and industry standards

Soft Skills and Cultural Fit

• Exceptional verbal and written communication skills, capable of explaining complex concepts clearly
• Strong interpersonal skills to effectively collaborate with team members and stakeholders
• Ability to thrive in a fast-paced, dynamic environment while managing multiple priorities
• Proactive problem-solving skills and a customer-centric mindset

Benefits and Perks

At [$COMPANY_NAME], we value our employees and offer a comprehensive benefits package that includes:

• Competitive salary range: [$SALARY_RANGE]
• Health, dental, and vision insurance
• 401(k) plan with company match
• Generous paid time off (PTO) and flexible work arrangements
• Professional development opportunities and training programs

Equal Opportunity Statement

[$COMPANY_NAME] is committed to creating a diverse and inclusive workplace. We are an Equal Opportunity Employer and welcome applications from all qualified individuals, regardless of race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. We encourage candidates from diverse backgrounds to apply.

Location

This is a remote position within [$COMPANY_LOCATION]. We encourage applicants who are within the geographical area to apply, as you will be expected to collaborate with local teams and stakeholders as needed.

We encourage all applicants, even those who may not meet every qualification, to apply and share how your unique experiences can contribute to our team.

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are looking for a Lead Claims Examiner who will take charge of managing the claims process for our organization. This role is crucial for ensuring that claims are processed efficiently and accurately, while also leading a team of claims examiners to achieve operational excellence and uphold industry standards.

Responsibilities

• Oversee the entire claims examination process, ensuring compliance with regulatory and organizational standards.
• Lead and mentor a team of claims examiners, fostering a culture of continuous improvement and professional development.
• Evaluate complex claims to determine benefits eligibility and assess the validity of claims through thorough investigation.
• Collaborate with cross-functional teams to address claims-related inquiries and ensure timely resolution of issues.
• Develop and implement best practices for claims processing and establish quality assurance measures to enhance accuracy.
• Prepare detailed reports on claims activities and present findings to senior management for strategic decision-making.

Required and Preferred Qualifications

Required:

• 5+ years of experience in claims processing or examination, with a demonstrated track record of leadership.
• In-depth knowledge of claims regulations, policies, and procedures in the insurance industry.
• Strong analytical skills with the ability to interpret complex information and make data-driven decisions.
• Exceptional communication skills, both verbal and written, to effectively interact with stakeholders.

Preferred:

• Experience with claims management software and tools.
• Professional certifications related to claims examination or insurance (e.g., AIC, CPCU).
• Proficiency in interpreting legal documents and regulations.

Technical Skills and Relevant Technologies

• Familiarity with claims management systems, such as Guidewire or similar platforms.
• Proficient in data analysis tools and techniques, including Excel and reporting software.
• Experience with document management systems for claims processing.

Soft Skills and Cultural Fit

• Proactive mindset with a strong focus on problem-solving and conflict resolution.
• Ability to work independently while also being a collaborative team player.
• High level of integrity and ethical standards in handling sensitive information.
• Adaptability to changing priorities and workloads in a dynamic environment.

Benefits and Perks

Annual salary range: [$SALARY_RANGE]

Additional benefits may include:

• Comprehensive health, dental, and vision insurance.
• Retirement savings plans with company match.
• Generous paid time off and holiday schedule.
• Professional development opportunities and tuition reimbursement.

Equal Opportunity Statement

[$COMPANY_NAME] is committed to diversity and inclusion in the workplace and is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, disability, or any other characteristics protected by law.

Location

This is a fully remote position.

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a highly skilled and experienced Claims Supervisor to lead and oversee our claims processing team. In this role, you will be responsible for ensuring efficient claims handling, maintaining compliance with industry regulations, and fostering a culture of excellence within the team. You will play a critical role in driving operational effectiveness and enhancing customer satisfaction.

Responsibilities

• Lead and mentor a team of claims adjusters, providing guidance, support, and performance feedback to enhance their professional development.
• Oversee the daily operations of the claims department, ensuring prompt and accurate processing of claims while adhering to company policies and regulatory requirements.
• Conduct regular audits of claims files to ensure compliance and identify areas for improvement in processes and procedures.
• Collaborate with cross-functional teams, including underwriting and customer service, to address claims-related issues and improve overall service delivery.
• Analyze claims data and trends to identify opportunities for process optimization and enhance operational efficiency.
• Act as a point of escalation for complex claims issues, providing expert guidance and resolution to challenging cases.

Required and Preferred Qualifications

Required:

• 5+ years of experience in claims management or a related field, with a proven track record of supervising teams.
• In-depth knowledge of claims processing, insurance regulations, and industry best practices.
• Strong analytical skills, with the ability to assess complex claims situations and make sound decisions.
• Excellent verbal and written communication skills to effectively convey information to team members and stakeholders.

Preferred:

• Experience in a leadership role within a remote work environment.
• Relevant industry certifications (e.g., AIC, CPCU) are a plus.

Technical Skills and Relevant Technologies

• Proficiency in claims management software and relevant technology tools.
• Familiarity with data analytics tools to interpret claims data and generate reports.
• Understanding of regulatory compliance requirements within the insurance industry.

Soft Skills and Cultural Fit

• Strong leadership skills with the ability to inspire and motivate a remote team.
• Exceptional problem-solving abilities, particularly in high-pressure situations.
• Demonstrated commitment to fostering a collaborative and inclusive team culture.
• Adaptability to change and a proactive approach to identifying opportunities for improvement.

Benefits and Perks

Salary range: [$SALARY_RANGE]

Additional benefits may include:

• Comprehensive health, dental, and vision insurance plans.
• Retirement savings plan with company matching contributions.
• Flexible work hours and the option for remote work.
• Generous paid time off and holiday policies.
• Professional development and training opportunities.

Equal Opportunity Statement

[$COMPANY_NAME] is an Equal Opportunity Employer and is committed to fostering a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, disability, veteran status, sexual orientation, or any other characteristic protected by applicable law.

Location

This is a fully remote position.

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are looking for a highly skilled Claims Manager to oversee our claims processing team at [$COMPANY_NAME]. In this role, you will be responsible for managing and optimizing the claims lifecycle, ensuring compliance with industry regulations, and enhancing customer satisfaction through effective claims management practices.

Responsibilities

• Lead and mentor a team of claims adjusters and support staff, fostering a culture of excellence and continuous improvement.
• Develop and implement strategic initiatives to improve claims processing efficiency and accuracy.
• Conduct regular audits of claims to ensure adherence to company policies, regulatory requirements, and industry best practices.
• Collaborate with cross-functional teams to resolve complex claims issues and enhance the overall claims experience for our customers.
• Analyze claims data and generate reports to provide insights into trends, risks, and opportunities for process enhancement.
• Act as the primary point of contact for escalated claims, resolving disputes and ensuring timely resolution.

Required and Preferred Qualifications

Required:

• 5+ years of experience in claims management or related field within the insurance industry.
• Strong understanding of claims processing workflows and regulatory compliance.
• Proven leadership skills with a track record of managing high-performing teams.
• Exceptional analytical and problem-solving abilities.

Preferred:

• Bachelor's degree in business, insurance, or a related field.
• Professional certifications such as CPCU, AIC, or similar.
• Experience with claims management software and data analytics tools.

Technical Skills and Relevant Technologies

• Proficient in claims management software and systems.
• Strong knowledge of data analysis and reporting tools.
• Familiarity with regulatory requirements affecting claims processes.

Soft Skills and Cultural Fit

• Excellent communication and interpersonal skills.
• Ability to work collaboratively in a fast-paced environment.
• Strong customer service orientation, with a focus on resolving issues efficiently.
• Proactive and adaptable, with a commitment to continuous improvement.

Benefits and Perks

Annual salary range: [$SALARY_RANGE]

Additional benefits may include:

• Health, dental, and vision insurance.
• Retirement savings plans with company matching.
• Paid time off and holiday pay.
• Professional development opportunities.

Equal Opportunity Statement

[$COMPANY_NAME] is committed to diversity in its workforce and is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, sex, gender expression or identity, sexual orientation or any other basis protected by applicable law.

Location

This role requires successful candidates to be based in-person at [$COMPANY_LOCATION].

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a strategic and results-oriented Director of Claims to lead our claims operations in a fully remote capacity. This role will be instrumental in driving the vision, strategy, and execution of our claims management processes, ensuring efficiency and customer satisfaction while maintaining compliance with regulatory standards.

Responsibilities

• Develop and implement claims strategies, policies, and procedures that align with the company's goals and enhance operational effectiveness.
• Lead and mentor a high-performing claims team, fostering a culture of accountability, continuous improvement, and professional development.
• Oversee the investigation, assessment, and resolution of claims, ensuring timely and fair outcomes for all stakeholders.
• Collaborate with cross-functional teams, including underwriting, legal, and customer service, to streamline claims processes and improve service delivery.
• Monitor key performance indicators (KPIs) and industry trends to identify opportunities for improvement and innovation within the claims function.
• Ensure compliance with all regulatory requirements and internal policies, conducting regular audits and risk assessments.
• Develop and maintain strong relationships with external partners, including vendors and regulatory agencies.

Required and Preferred Qualifications

Required:

• 10+ years of experience in claims management or a related field, with at least 5 years in a leadership role.
• Proven track record of developing and executing claims strategies that improve operational efficiency and enhance customer satisfaction.
• Strong understanding of claims regulations, compliance requirements, and industry best practices.
• Exceptional analytical, problem-solving, and decision-making skills.
• Excellent communication and interpersonal skills, with the ability to build relationships at all organizational levels.

Preferred:

• Experience with digital transformation initiatives within claims processing.
• Professional certifications in claims management, such as AIC, CPCU, or similar.
• Familiarity with data analytics tools and claims management software.

Technical Skills and Relevant Technologies

• Deep knowledge of claims management systems and technology platforms.
• Experience with data analytics and reporting tools to drive operational insights.
• Proficiency in project management methodologies to oversee claims initiatives.

Soft Skills and Cultural Fit

• Leadership skills with a focus on team empowerment and development.
• Strong adaptability and resilience in a fast-paced, evolving environment.
• Proactive approach to problem-solving and innovation.
• Commitment to fostering an inclusive and respectful workplace culture.

Benefits and Perks

We offer a competitive salary range of [$SALARY_RANGE], along with an attractive benefits package that includes:

• Comprehensive health, dental, and vision insurance.
• Retirement savings plan with company match.
• Flexible work hours and unlimited paid time off.
• Professional development opportunities and continuing education stipends.
• Wellness programs and mental health support.

Equal Opportunity Statement

[$COMPANY_NAME] is committed to creating a diverse and inclusive workplace. We are an Equal Opportunity Employer and welcome applications from all qualified candidates regardless of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other basis protected by applicable law.

Location

This is a fully remote position.

Note: By submitting your application, you agree to our data processing terms as outlined in our Global Data Privacy Notice for Job Candidates and Applicants.

Company Overview

[$COMPANY_OVERVIEW]

Role Overview

We are seeking a highly experienced Vice President of Claims to lead our claims operations and strategy at [$COMPANY_NAME]. In this executive role, you will be responsible for overseeing the entire claims lifecycle, ensuring operational excellence, and driving continuous improvement initiatives. Your leadership will shape our claims processes, enhance customer satisfaction, and contribute to our organizational goals of integrity and efficiency.

Responsibilities

• Develop and implement a comprehensive claims strategy that aligns with the organization's overall objectives and enhances operational efficiency.
• Lead and mentor a high-performing claims management team, fostering a culture of excellence, accountability, and professional growth.
• Establish key performance indicators (KPIs) to measure claims performance and implement data-driven decision-making processes.
• Collaborate with cross-functional teams, including underwriting, finance, and customer service, to ensure seamless claims processing.
• Advocate for technology enhancements in claims management systems to streamline operations and improve the customer experience.
• Monitor industry trends and regulatory changes to ensure compliance and adapt strategies accordingly.
• Engage with stakeholders to communicate claims performance, challenges, and opportunities for improvement.

Required and Preferred Qualifications

Required:

• 15+ years of experience in claims management within the insurance industry, with a proven track record of leadership and operational excellence.
• Strong understanding of claims processes, regulations, and best practices.
• Excellent analytical and problem-solving skills, with the ability to leverage data to drive strategic decisions.
• Exceptional communication and interpersonal skills to effectively engage with stakeholders at all levels.

Preferred:

• Advanced degree in business administration, insurance, or a related field.
• Experience in digital transformation initiatives within claims management.
• Proven track record of driving change and improving claims outcomes in a fast-paced environment.

Technical Skills and Relevant Technologies

• Proficiency in claims management software and data analytics tools.
• Experience with process mapping and workflow optimization methodologies.
• Familiarity with regulatory compliance frameworks in the insurance sector.

Soft Skills and Cultural Fit

• Strong leadership presence with the ability to inspire and motivate teams.
• Results-oriented mindset with a focus on achieving operational goals.
• Ability to adapt to changing environments and manage ambiguity effectively.
• Commitment to fostering an inclusive and collaborative workplace culture.

Benefits and Perks

We offer a competitive salary package commensurate with experience and performance, along with comprehensive benefits that may include:

• Health, dental, and vision insurance
• Retirement savings plan with company match
• Generous paid time off and holiday schedule
• Professional development opportunities

Equal Opportunity Statement

[$COMPANY_NAME] is committed to diversity in its workforce and is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, creed, gender, national origin, age, disability, veteran status, sex, gender expression or identity, sexual orientation or any other basis protected by applicable law.

Location

This role is remote within [$COMPANY_LOCATION].