Claims Clerk I reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk I verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk I processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk I works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience.
Claims Supervisor I supervises activities in the claims department. Leads the examination of personal and property and casualty insurance claims based on policy provisions, appraisal, and verifiable damage. Being a Claims Supervisor I interacts with claimants and oversees the review of records and documentation to ascertain insurance coverage. Supervises settlement negotiations within authorized limits and escalates claims exceeding authorization. Additionally, Claims Supervisor I may conduct team training. May require a bachelor's degree. Typically reports to a manager or head of a unit/department. Working team member that may validate or coordinate the work of others on a support team. Suggests improvements to process, is a knowledge resource for other team members. Has no authority for staff actions. Generally has a minimum of 2 years experience as an individual contributor. Thorough knowledge of the team processes.
The Claims Investigator I corresponds with policyholders, claimants, witnesses, attorneys, etc. to gather important information to support contested insurance claims. Denies, settles, or authorizes payments to routine property/casualty claims based on coverage, appraisal, and verifiable damage. Being a Claims Investigator I prepares reports of investigation findings. Makes recommendations for settlement of routine property/casualty claims based on coverage, appraisal, and verifiable damage. In addition, Claims Investigator I may conduct field evaluations to inspect and document damage or loss. Typically requires an associate's degree. Typically reports to a supervisor or manager. Being a Claims Investigator I works on projects/matters of limited complexity in a support role. Work is closely managed. Working as a Claims Investigator I typically requires 0-2 years of related experience.
Claims Examiner I reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner I studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner I determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner I work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner I typically requires 0-2 years of related experience.
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