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Finance
Insurance Claim Investigator
What They Do
About This Career
Reviews settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confers with legal counsel on claims requiring litigation. May also settle insurance claims.
This career is part of the Finance cluster Insurance pathway.
A person in this career:
- Examines claims forms and other records to determine insurance coverage.
- Analyzes information gathered by investigation and reports findings and recommendations.
- Pays and processes claims within designated authority level.
- Investigates, evaluates, and settles claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Verifies and analyzes data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Reviews police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Investigates and assesses damage to property and creates or reviews property damage estimates.
- Interviews or corresponds with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Interviews or corresponds with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Enters claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
Working Conditions and Physical Demands
People who do this job report that:
- You would sit most of the time. There's some walking and standing. You may have to lift and carry things like books, papers or tools weighing 10 lbs. or less.
- Work in this occupation requires being inside most of the time
- Work in this occupation involves sitting more than one-third of the time
Working in this career involves (physical activities):
- Seeing clearly up close
- Speaking clearly enough to be able to be understood by others
- Identifying and understanding the speech of another person
Work Hours and Travel
- Irregular hours
- Overnight travel
Specialty and Similar Careers
Careers that are more detailed or close to this career:
- Field Claims Adjuster
- Claims Adjuster — Investigates insurance claims in order to determine if the policy will cover the damages that are being claimed and to determine if the claim is legitimate.
- Claims Analyst
- Claims Examiner
- Claims Representative
- Claims Specialist
- Corporate Claims Examiner
- Home Office Claims Specialist
- Litigation Claims Representative
- General Adjuster
Every year the U.S. Department of Labor conducts national surveys of wage data by occupation in every state and in all industry divisions. These surveys are conducted through the Occupational Employment Statistics (OES) program.
The statistics collected for one year are published the next fall. For example, 2013 wage information was published in the fall of 2014.
There are over 800 occupations in the surveys, and these occupations cover the entire U.S. labor market. The surveys ask for reports in a scale of ranges for both hourly wages and annual wages.
In many cases, these occupations are broad enough to cover many more detailed specialties of an occupation. A specific occupation may be included in a broader occupational category for which labor market data is available. When you look at the statistics for a broad category, be aware that the salary data for a specific career may differ.
For more details about how wage information is collected and calculated by the U.S. Department of Labor, visit their website at http://www.bls.gov/bls/blswage.htm.
Every year the U.S. Department of Labor conducts a national survey of over 400,000
employers in every state and in all industry divisions. This survey is conducted
through the Occupational Employment Statistics (OES) program. Every other year the
department publishes outlook information based on these surveys.
Each outlook period covers 10 years. For example, in 2003 the outlook information
was published for 2004-2014. Employers are asked to report the number of employees
in about 770 different occupations that cover the entire U.S. labor market.
From this information, staffing patterns for different industries are established.
Industry growth is projected into the future based on past trends and current economic
conditions. Industry staffing patterns are then applied to the industry projections
to obtain occupational projections.
In many cases, these occupations are broad enough to cover many more detailed specialties
of an occupation. A specific occupation may be included in a broader occupational
category for which labor market data is available. When you look at the statistics
for a broad category, be aware that the employment data for a specific field may
differ.
For more details about how employment information is collected and calculated by
the U.S. Department of Labor, visit their website at http://stats.bls.gov/news.release/ocwage.tn.htm.
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