Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Verifies coverage eligibility. Calculates settlement amounts according to guidelines. Processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. 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.
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. 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. May conduct team training. May require a bachelor's degree. Typically reports to a manager or head of a unit/department. Supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. Typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision.
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.
Reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. 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. Determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. Work is closely managed. Works on projects/matters of limited complexity in a support role. Typically requires 0-2 years of related experience.
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