A claims examiner has a little different role than that of an adjuster, who looks into the facts of an insurance claim. The examiner is responsible for making sure that all relevant guidelines, legal requirements and regulatory demands are met. Most insurance examiners work for health insurance or life insurance companies.
In the case of a health care claim, the examiner will determine whether the cost of the claim is reasonable for the diagnosis. In order to get a fix on this issue, an examiner uses tables that provide average costs for medical procedures, expected procedures for specific diagnoses, average hospital stays for certain procedures, etc. Examiners are the individuals that authorize treatments - or refer the request to an investigator for a closer look. In life insurance, an examiner investigates the cause of death, or may be called on to look into the health of a new life insurance applicant.
There are no formal education requirements for an insurance claims examiner, but over half of the professionals in the field today hold a bachelor's or associate's degree. Employers are increasingly looking for applicants with post secondary education in order to handle the increasingly complex nature of medical care in general and the treatment options that continue to expand.
There were 319,000 insurance adjusters, examiners, investigators and appraisers working in 2006, according to the Department of Labor.
The job opportunities in this field are expected to grow about as fast as average; in the range of 11% to 14% over the next several years. Competition in the field is fairly steep because it draws applicants from law enforcement and the military.
10th Percentile $34,140
Median Salary $55,760
20th Percentile $84,260
Source: U.S. Department of Lab