Claims Examiner
An insurance company employee who reviews and evaluates property damage claims from the office. Claims examiners approve or deny claims, authorize payments, and oversee the work of field adjusters.
What Is a Claims Examiner
A claims examiner is an insurance company employee who reviews, evaluates, and makes decisions on property damage claims. They work from the carrier's office and are responsible for ensuring claims are processed according to policy terms, company guidelines, and state regulations.
Role in the Claims Process
The claims examiner receives the adjuster's inspection report and estimate, reviews coverage under the policy, identifies any coverage issues or exclusions, and authorizes the claim payment. On complex or high-value claims, the examiner may request additional documentation or a reinspection.
Working with Claims Examiners
When submitting supplements or disputing a claim decision, the claims examiner is often the decision-maker. Presenting clear, well-organized documentation makes their review process faster. Understanding that examiners are evaluating coverage (not just damage) helps frame supplement requests in terms the examiner needs to see.
Frequently asked questions
A claims examiner reviews claim files, evaluates coverage, approves or denies claims, authorizes payment amounts, and ensures claims are handled according to company guidelines and state regulations. They work from an office rather than visiting properties in the field.
An adjuster typically inspects the property and writes the estimate. A claims examiner reviews the adjuster's work, makes coverage decisions, and authorizes payments. In some companies, one person handles both roles.
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