Become a Claims Examiner: Step-by-Step Guide

Jul 14, 2018

Find out how to become a claims examiner. Research the training requirements, and learn about the experience you need to advance your career in the insurance industry.

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  • 0:03 Becoming a Claims Examiner
  • 0:45 Career Requirments
  • 1:32 Step 1: Earn a…
  • 2:37 Step 2: Obtain a State License
  • 3:03 Step 3: Work as a Trainee
  • 3:31 Step 4: Continue Your…

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Becoming a Claims Examiner

So you think you might like to become a claims examiner? Claims examiners work for property and casualty (or P&C) firms as well as life and health insurance companies. Depending on the industry employed in, job titles might be medical claims examiner, workers' compensation examiner, property claims adjuster, or bodily injury claims examiner. A claims examiner's job duties include reviewing claims submitted for payment to ensure guidelines have been followed by insurance adjusters and claimants, deciding the claim amount the company should pay and negotiating settlements. Claims examiners work full time, usually with evening or weekend hours to meet clients' needs. They may also travel offsite to assess damages.

Career Requirements

Degree Level High school diploma; more complex positions usually require a bachelor's degree
Degree Field No specific field of study; options include risk management and insurance, healthcare risk management or a degree related to the type of claims to be examined
Licensure Some states require licensure
Experience Many claims examiners start as trainees
Key Skills Math, analytical, communication and communication skills
Salary $38,709 per year (2015 median salary for all claims examiners)

Sources: U.S. Bureau of Labor Statistics, Online Job Postings (July to August 2015), (August 2015)

So what are the career requirements? Starting with the right education is important. Employers look for someone with at least a high school diploma for entry-level positions. However, some employers prefer someone with a bachelor's degree. The degree field can be risk management and insurance, healthcare risk management, business, or accounting. The requirements to become licensed can vary by state. Most employers look for someone with experience, which can sometimes be obtained through on-the-job training. Key skills are:

  • Detail-oriented
  • Math skills
  • Analytical skills
  • Communication skills
  • Interpersonal skills

According to the U.S. Bureau of Labor Statistics, the median salary for claims adjusters, appraisers, examiners, and investigators is $63,060.

Step 1: Earn a Bachelor's Degree

Although some claims examiners have only a high school diploma, a bachelor's degree may be required for more complex examiner roles. While there are no specific degree requirements for claims examiners, candidates can consider a degree program, such as risk management and insurance or healthcare risk management. For someone who wants to work with business claims, a degree in business or accounting might be helpful. Students should also seek out elective coursework or minor programs to focus their studies toward their career field of interest. For example, coursework in medical terminology or medical coding is desirable when pursuing a career as a health or life insurance claims examiner, while classes in architecture could aid someone wishing to work in industrial insurance.

Success Tip:

  • Seek education in your desired field. Certain sectors of the insurance industry are expected to see more job growth than others from 2012 to 2022. Healthcare-related insurance work is expected to have more job opportunities for claims examiners than automotive insurance.

Step 2: Obtain a State License

Some states require claims examiners pass a licensing exam or complete a pre-licensing education to test their knowledge of government insurance regulations. Some states allow examiners to work under the company's license until they qualify for their own. States vary on the amount of work experience required to obtain a license, so becoming a trainee is usually necessary.

Step 3: Work as a Trainee

Insurance companies often hire new claims examiners as trainees. Under the supervision of a senior claims examiner, trainees work on simple cases until they are ready to tackle larger, more complex claims. After gaining experience, examiners may seek advancement opportunities, such as becoming a senior claims representative, supervisor, underwriter or administrator.

Step 4: Continue Your Education

The insurance claims environment changes with new government regulations. Most insurance claim examiners, underwriters, adjusters and investigators routinely take courses offered by the industry to keep their skills up-to-date. Additionally, pursuing a master's degree in risk management or a specific insurance field may provide a better understanding of the industry.

Success Tip

  • Get involved with professional associations. To improve career opportunities, claims examiners may attend industry work fairs and network with industry professionals to learn about potential job openings. Professional groups also regularly provide additional training through workshops, seminars and classes.

Earning a bachelor's degree, obtaining a license, working as a trainee, and continuing your education are great steps to follow to make the most of a career as a claims examiner.

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