Claims Examiners, Property and Casualty Insurance

Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

tasks jobzones knowledge skills abilities work_activities work_context interests work_styles work_values

Tasks

• Communicate with reinsurance brokers to obtain information necessary for processing claims.

• Report overpayments, underpayments, and other irregularities.

• Prepare reports to be submitted to company's data processing department.

• Confer with legal counsel on claims requiring litigation.

• Contact or interview claimants, doctors, medical specialists, or employers to get additional information.

• Conduct detailed bill reviews to implement sound litigation management and expense control.

• Present cases and participate in their discussion at claim committee meetings.

• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

• Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

• Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

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Job Zone

• Name: Job Zone Three: Medium Preparation Needed

• Experience: Previous work-related skill, knowledge, or experience is required for these occupations. For example, an electrician must have completed three or four years of apprenticeship or several years of vocational training, and often must have passed a licensing exam, in order to perform the job.

• Education: Most occupations in this zone require training in vocational schools, related on-the-job experience, or an associate's degree. Some may require a bachelor's degree.

• Job training: Employees in these occupations usually need one or two years of training involving both on-the-job experience and informal training with experienced workers.

• Examples: These occupations usually involve using communication and organizational skills to coordinate, supervise, manage, or train others to accomplish goals. Examples include funeral directors, electricians, forest and conservation technicians, legal secretaries, interviewers, and insurance sales agents.

• Svp range: (6.0 to < 7.0)

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Knowledge

Browse Knowledge

• Customer and Personal Service
  Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

• Clerical
  Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.

• English Language
  Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

• Computers and Electronics
  Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

• Law and Government
  Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

• Education and Training
  Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.

• Mathematics
  Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

• Medicine and Dentistry
  Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.

• Psychology
  Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.

• Administration and Management
  Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

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Skills

Browse Skills

• Judgment and Decision Making
  Considering the relative costs and benefits of potential actions to choose the most appropriate one.

• Reading Comprehension
  Understanding written sentences and paragraphs in work related documents.

• Critical Thinking
  Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

• Writing
  Communicating effectively in writing as appropriate for the needs of the audience.

• Active Listening
  Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

• Instructing
  Teaching others how to do something.

• Speaking
  Talking to others to convey information effectively.

• Time Management
  Managing one's own time and the time of others.

• Persuasion
  Persuading others to change their minds or behavior.

• Active Learning
  Understanding the implications of new information for both current and future problem-solving and decision-making.

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Abilities

Browse Abilities

• Oral Comprehension
  The ability to listen to and understand information and ideas presented through spoken words and sentences.

• Written Comprehension
  The ability to read and understand information and ideas presented in writing.

• Oral Expression
  The ability to communicate information and ideas in speaking so others will understand.

• Deductive Reasoning
  The ability to apply general rules to specific problems to produce answers that make sense.

• Problem Sensitivity
  The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.

• Near Vision
  The ability to see details at close range (within a few feet of the observer).

• Speech Recognition
  The ability to identify and understand the speech of another person.

• Written Expression
  The ability to communicate information and ideas in writing so others will understand.

• Inductive Reasoning
  The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).

• Information Ordering
  The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).

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Work Activities

Browse Work Activities

• Making Decisions and Solving Problems
  Analyzing information and evaluating results to choose the best solution and solve problems.

• Establishing and Maintaining Interpersonal Relationships
  Developing constructive and cooperative working relationships with others, and maintaining them over time.

• Communicating with Persons Outside Organization
  Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.

• Getting Information
  Observing, receiving, and otherwise obtaining information from all relevant sources.

• Organizing, Planning, and Prioritizing Work
  Developing specific goals and plans to prioritize, organize, and accomplish your work.

• Documenting/Recording Information
  Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.

• Communicating with Supervisors, Peers, or Subordinates
  Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.

• Resolving Conflicts and Negotiating with Others
  Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.

• Identifying Objects, Actions, and Events
  Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.

• Processing Information
  Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.

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Work Context

• Structured versus Unstructured Work
  To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals?

• Indoors, Environmentally Controlled
  How often does this job require working indoors in environmentally controlled conditions?

• Spend Time Sitting
  How much does this job require sitting?

• Face-to-Face Discussions
  How often do you have to have face-to-face discussions with individuals or teams in this job?

• Importance of Being Exact or Accurate
  How important is being very exact or highly accurate in performing this job?

• Contact With Others
  How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?

• Telephone
  How often do you have telephone conversations in this job?

• Freedom to Make Decisions
  How much decision making freedom, without supervision, does the job offer?

• Time Pressure
  How often does this job require the worker to meet strict deadlines?

• Frequency of Decision Making
  How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?

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Interests

Browse Interests

• Conventional
  Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.

• Enterprising
  Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.

• Social
  Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.

• Investigative
  Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.

• Realistic
  Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.

• Artistic
  Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.

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Work Styles

• Dependability
  Job requires being reliable, responsible, and dependable, and fulfilling obligations.

• Attention to Detail
  Job requires being careful about detail and thorough in completing work tasks.

• Integrity
  Job requires being honest and ethical.

• Adaptability/Flexibility
  Job requires being open to change (positive or negative) and to considerable variety in the workplace.

• Analytical Thinking
  Job requires analyzing information and using logic to address work-related issues and problems.

• Cooperation
  Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.

• Stress Tolerance
  Job requires accepting criticism and dealing calmly and effectively with high stress situations.

• Initiative
  Job requires a willingness to take on responsibilities and challenges.

• Self Control
  Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.

• Persistence
  Job requires persistence in the face of obstacles.

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Work Values

Browse Work Values

• Company Policies and Practices
  Workers on this job are treated fairly by the company.

• Supervision, Human Relations
  Workers on this job have supervisors who back up their workers with management.

• Working Conditions
  Workers on this job have good working conditions.

• Security
  Workers on this job have steady employment.

• Advancement
  Workers on this job have opportunities for advancement.

• Support-Mean Extent
  Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.

• Responsibility
  Workers on this job make decisions on their own.

• Independence
  Workers on this job do their work alone.

• Working Conditions-Mean Extent
  Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.

• Activity
  Workers on this job are busy all the time.

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