Job Responsibilities
As a claims examiner, I make decisions on injury and disability
claims. I order medical records, conduct recorded interviews
with claimants, obtain job descriptions, and consult with
medical resources if needed. I write approval and denial letters
that explain our decisions. I may communicate with attorneys or
the state department of insurance on some claims. I may have to
provide legal testimony if a claim is disputed in court.
|
Job Requirements
Usually a four year degree is needed if you do not have any
claims experience. Business, Finance etc is preferred, but
almost any will do. Experience in investigations, law
enforcement, or working for an insurance agency or carrier will
assist you in obtaining this position. In some jurisdictions a
license from the state may be needed to adjust claims. Already
having a license will make you a more attractive employee.
|
Uppers
A lot of decision-making power and autonomy. Usually there are more than enough
claims to go around so your boss doesn't have time to micromanage you once you
are out of your trainee period. I enjoy the challenge of making the correct
decision and uncovering attempts at insurance fraud. You might order surveillance
and those tapes can be hilarious!
Job security- Steady work which is not dependent on the economy. In fact when
the economy is bad, more insurance claims are expected.
|
Downers
Lots of paperwork and legal time limits on when it has to be
completed. A sudden rush of claims or a few people quitting can
snow the remaining examiners down with work until new people can
be hired and trained. It's not like other businesses where you
can refuse business or say you don't have the time to fit them
in. We sold the policy so we have to take the claims. May
involve late nights or weekend work and claims adjusters are
usually on salary, so no OT pay.
|
Lifestyle
Most times hours are 9-5pm. There is no call out in the early morning hours for
claims unless you work on the catastrophe unit and go to a disaster. (This pays
mucho dinero so worth considering if you don't have a family.) Travel is rare in
my type of claims. Dress is business casual.
|
Compensation
My base to start about 7 years ago was $32,000. I think our base
now is about $34,000. If you have any insurance related
experience you can negotiate a little higher. I knew people who
started with me who negotiated and added 2-3k more to their base
salary for some very minor experience. A yearly bonus is based
on the company's profits. Mine has been as low as a few hundred
dollars and as high as 11% of pay, but since that varies so much
you can't really depend on it as income. A small individual
contribution bonus is available at my company. One year I
received $320. Another year $200, so it is really nothing to
write home about. I actually think my boss just divides whatever
bonus money she gets between the team members because we all
contribute. After a few years doing the job, you should be
making in the mid forties. However, I am in a low wage southern
state, so these figures would be much more somewhere like NY or
CA with a higher cost of living.
Insurance companies usually have great benefits. I have a 401K
with 50% match up to 6% of your salary, a pension (still!) that
I don't need to contribute anything to, health insurance,
dental, fully paid short term disability, employee contribution
long term disability, paid life insurance, and quite a few other
little bens that might be useful.
|
Advice to Jobseekers
I wish someone had told me this when I started. Most important:
When you first contact your claimant, set a time expectation.
For example, it should take 10 days for me to gather this
information. I will not be able to have a decision until after
that time. When I have a decision, I will contact you. This way
they do not call you every day and take up your time. If you
have 50 claims and they all call you every day, you will not
have time to do anything else. Once the expectation is set up
front that they cannot have a decision for however long, this
keeps them from getting frustrated and irate because in their
mind you should have had their claim completed sooner. Believe
me, this will make your life easier and save you customer
complaints.
You need to have good written communication skills because you
will write a lot of letters explaining complex policy provisions
and there is a lot of paperwork.
You will also deal with irate claimants on the phone and need to
have a thick skin because some people can get nasty when their
claim is not paid. Good customer service and verbal communcation
skills are a must.
|
|
