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How to Become an Insurance Claims Examiner

Research the requirements to become an insurance claims examiner. Learn about the job duties, and read the step-by-step process to start a career in the insurance claims examination field. View article »

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  • 0:00 Should I Become an…
  • 0:52 Career Requirements
  • 1:56 Step 1: Earn a Certificate
  • 3:27 Step 2: Meet State…
  • 4:19 Step 3: Complete…

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Video Transcript

Should I Become an Insurance Claims Examiner?

Insurance companies, the government and healthcare organizations all employ insurance claims examiners to investigate and process claims made by the public. Examiners must find out if the claim submitted is covered by the client's policy, check to make sure that it's not fraudulent and negotiate a settlement. In determining the settlement amount, examiners typically consult with the company's legal team and interview involved parties, such as the claimant's employer or physician, for additional information. These professionals then prepare a report outlining the investigation's results and the company's financial liability. Work hours might vary, and they may need to work evenings and weekends to meet other parties' scheduling needs.

Career Requirements

Education Level High school diploma or equivalent; professional certificate program; some employers prefer a bachelor's degree
Degree Fields No specific field required; background in business or accounting helpful
Experience Vocational training or previous work experience in the insurance field beneficial
Licensure/Certification Licensure required by some states; voluntary certification available
Key Skills Verbal and written communication, math, research and negotiation skills; good judgment; knowledge of insurance claims and fraud detection software
Salary $63,060 (2015 median salary for all insurance claims adjusters, appraiser, examiners, and investigators)

Sources: U.S. Bureau of Labor Statistics, O*NET OnLine, Salary.com (August 2015)

A high school diploma is the minimum requirement. Aspiring insurance claims examiners should complete a professional certificate program. Some employers prefer a bachelor's degree. No specific degree field is required, but a background in business or accounting can be helpful in attaining employment. Many employers seek candidates with vocational training or previous work experience in the insurance field. Licensure may be required by some states. Voluntary certification is available. Key skills include verbal and written communication, math, research and negotiation skills; good judgment; and knowledge of insurance claims and fraud detection software. According to the U.S. Bureau of Labor Statistics, the median annual salary for all insurance claims adjusters, appraisers, examiners and investigators was $63,060 as of May 2015. Let's go over the few steps to become an insurance claims examiner.

Step 1: Earn a Certificate

Typically, a high school diploma is the minimum educational requirement for insurance claims examiners. However, employers may look for applicants with some formal training. Insurance claims examiner certificate programs are available at community colleges and universities for individuals with no prior experience. These programs might cover insurance terminologies, the claims process, customer service techniques and laws related to insurance fraud. Students also may be able to earn the certificate via online study.

Success Tips:

  • Use high school courses to gain experience in the field. One of the ways that insurance claims examiners can prepare for this career early on is by taking computer classes in high school. Examiners must use computer software to assemble reports and research data. Depending on their insurance specialization, prospective examiners could also find high school coursework in healthcare or auto technology beneficial.
  • Go on to earn a bachelor's degree. Although an undergraduate degree isn't required to work as an insurance claims examiner, earning a bachelor's degree may help job applicants stand out to employers. A variety of degree fields are acceptable, including accounting, finance, insurance and healthcare administration.

Step 2: Meet State Licensure Requirements

Every state has its own rules regarding licensure for claims examiners. The BLS states that many employees who work for insurance companies don't need to be licensed individually. In some states, only adjusters need a license. In other instances, certification is needed for particular insurance specialties, such as workers' compensation. State requirements for this career are typically posted through the state's department of insurance, business regulations or a similar division. Common requirements include being at least 18 years old, having a valid driver's license and securing full-time employment with an insurance company. Continuing education is needed to renew any license or certification.

Step 3: Complete On-the-Job Training

Before becoming an insurance claims examiner, entry-level trainees often need to work with a supervisor. By doing so, they'll better understand the industry and the nature of the job. As they complete simpler claims examinations, trainees can be assigned more difficult tasks until they can prove their competency and ability to work alone.

Success Tip:

  • Consider earning professional certification. Optional certifications that are available to insurance claims examiners include the Associate in Claims designation through the American Institute for Chartered Property Casualty Underwriters (www.aicpcu.org). This program is available online and has tracks in auto, liability, workers' compensation and property. The designation requires applicants to take appropriate courses in their certification track and pass an exam.

Insurance claims examiners must have a high school diploma, be licensed and complete on-the-job training.

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