Pros and Cons of Being an Insurance Examiner
An insurance examiner, also called a claims examiner, reviews claims to make sure things are in order and guideline requirements have been met. Find out realistic job expectations including the pros and cons of being an insurance examiner to decide if this position is right for you.
| Pros of Being an Insurance Examiner |
|---|
| Minimum high school diploma needed* |
| No specific college degree required* |
| Usually work in comfortable office environment* |
| Mainly 40 hours, five days a week schedule* |
| Cons of Being an Insurance Examiner |
|---|
| Most employers prefer college graduates* |
| Some states may require you to pass a licensing exam* |
| Need good driving record if job requires traveling* |
| May involve insurance adjuster duties (long work hours and significant traveling)* |
Source: *U.S. Bureau of Labor Statistics (BLS)
Job Descriptions, Career and Salary Info
As an insurance examiner, your primary responsibility is to verify the work of appraisal agents or adjusters. Some job duties you may have that are common to all insurance fields include analyzing claim documents to determine limits of insurance coverage; approving, denying or referring claims to an investigator if fraud other unusual activity is suspected and consulting with third party professionals and policy holders to gather more information.
With the majority of insurance examiners working in the healthcare industry, typical duties involve assessing medical diagnosis and treatments to determine if costs are justified and comparing length of treatment and hospital stays to the cost of a claim. If you plan on working in the property and casualty industry, some of your duties may consist of reviewing property damage estimates to determine liability, reviewing police reports and witness statements, and consulting with reinsurance brokers, contractors and architects.
Job Outlook and Salary
The BLS projected an average employment growth of three percent from 2012-2022 for claims examiners, which also included claims adjusters, appraisers and investigators. The BLS also noted that you can expect to find more job opportunities in the healthcare industry, as the need for examiners to be stringent with reducing medical claim costs will be significant.
As a claims examiner, adjustor or investigator, you can expect to earn a median salary of $62,220, according to the BLS May 2014 wage report. During this time, the insurance industry employed the largest number of professionals in this field, and the highest paid workers were employed by architectural, engineering and related services. The average annual salary earned by those workers was about $90,000.
What Are the Requirements?
According to the BLS, a high school diploma is the minimum education required for insurance or claims examiners. Despite this, most companies prefer to hire those who have a 4-year degree or related work experience. Although no specific degree is required for this position, programs in accounting, business or architecture can be helpful when assessing claim amounts, financial loss or property damage, according to the BLS.
Additionally, it is imperative that you participate in continuing education courses to stay abreast of the latest state and federal regulations concerning claim procedures. For a career in healthcare claims, remaining knowledgeable in areas such as medical procedures, different types of insurance plans and prescription drug benefits can be beneficial. For positions that involve auto or property claims, keeping up to date with the latest vehicle models and areas prone to natural disasters can be helpful.
Job Postings from Real Employers
Unless applying for a trainee position, a typical insurance examiner job will most likely require that you have some experience in the field. Most of these jobs are advertised as claims examiner in a variety of insurance segments, such as property and casualty, life, disability and worker's compensation. Following are some claims examiner job postings that can give you an idea of what real employers were looking for during February 2012:
- A staffing agency in the state of Vermont looked to fill statewide positions for life claim examiners at a life insurance company. This company preferred candidates with a bachelor's degree and offered a salary of $50,000-$55,000.
- An Oak Brook, IL, retirement company advertised for a disability claims examiner with at least two years of education or work experience, including knowledge of medical terminology and coding.
- An Irvine, CA, property and casualty insurance company looked for a worker's compensation claims examiner with a 4-year degree or industry certification, plus three years experience in the field.
- A Philadelphia, PA, health insurance company sought a claims examiner who had a high school diploma or equivalent, with at least a year of experience in claims processing and knowledge of medical billing and coding.
How to Stand Out
The first step in standing out is earning a bachelor's degree. A specific industry-related degree program, such as risk management or insurance, may give you a more competitive edge over those with degrees in less-specialized areas. If completing a 4-year program is not suitable for you, completing a certificate program is a satisfactory alternative. You may also complete a certificate program in risk management and insurance, as well as a certificate program in claims examining or medical billing and coding.
To further demonstrate your level of competency in the field, you may opt for licensure or certification, if these are available in your state. Some states, including Oregon and Montana, offer certification for workers compensation claims examiners. Since some of your duties may involve that of a claims adjuster, you may consider certifications such as the Property Technical Certification, offered by AdjusterPro. This certification is offered in 16 U.S. states.
Other Career Paths
If you have strong attention to detail and you're analytical and thorough, but you're not sure if being an insurance examiner is right for you, you might consider a position as a tax examiner. In this position, you would also ensure that documents submitted, such as tax returns, are filed properly and in compliance with regulations. Although the functions of an insurance and tax examiner may be similar, a bachelor's degree is often required to be a tax examiner, and the median salary is lower, at $50,000 annually.
If you're good at balancing your personal checkbook, you may also be good at doing similar tasks on a broader scale as a bookkeeping clerk. This position also requires an eye for spotting errors and making sure items such as expenses and earnings are documented accurately. Although this career field has a higher projected employment growth of 14% from 2010-2020, you would earn a moderately lower median wage of about $35,000 annually, as of May 2011.
