Claims Examiner Training Programs and Requirements

Insurance companies employ claims examiners to review claim applications for accuracy and cost verification. Claims examiners also decide whether to authorize or deny payment of a claim or to refer it for further investigation. Individuals can acquire skills in claims examining by completing various degree programs or informal, on-the-job training.

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Claims Examiner Training Requirements and Recommendations

According to the U.S. Bureau of Labor Statistics (BLS), a high school diploma may be adequate to find employment as a claims examiner (www.bls.gov). However, some 2- or 4-year degree programs might complement jobs within insurance specialties, such as health or liability insurance claims examiner.

No matter which avenue of training they pursue, aspiring claims examiners must develop excellent communication skills since they will work closely with other insurance workers and numerous claimants. They must also be computer savvy. Many claims examiners transport and set up laptops, portable printers, scanners and fax machines at on-site claims locations. Although most work a typical 40-hour week, claim examiners must be ready to work longer, more irregular hours if natural or manmade disasters occur.

Formal Education

Most claims examiners learn their trade through paid, informal employee training programs. However, various undergraduate degree programs could be beneficial for those seeking employment within insurance specialties.

On-The-Job Training Programs

It's common for entry-level claims examiners to train under the supervision of experienced professionals. They learn to examine insurance claims to determine reasonability of costs or repairs, accuracy of application and payment authorization or denial. Claims examiners also learn to spot fraudulent claims and report these findings to investigators for further review. Much of this training is done in the field with actual insurance claims.

Undergraduate Degree Programs

Although there are no specific degree requirements for claims examiners, degree programs in auto body repair, architecture, business, law or medicine could lend formal expertise to claims examiners within those related insurance specialties.

Auto body degree programs train individuals to repair vehicles and estimate costs associated with damaged cars, trucks, motorcycles and other recreational vehicles. Property claims examiners might choose to complete an architecture degree program to learn about basic construction principles, building codes and regulations, and fire proofing methods. Those interested in liability insurance might choose to complete a degree program in business or law. Finally, medical or life insurance claims examiners could benefit from a degree program in medicine.

Job Experience

Claims examiners gain expertise through practical, hands-on training. That's why many companies provide supervised, on-the-job experiences for new employees. This training often revolves around insurance specialties, such as property and casualty insurance, health insurance or life insurance.

Licensing

Licensure for claims examiners varies by state. Most require claims examiners to complete educational requirements prior to licensing or pass state-mandated licensing examinations. Some states don't require individuals to be licensed personally and allow these professionals to work under general company licenses. States requiring licensure generally have continuing education guidelines for license renewal.

Workshops and Seminars

National workshops and seminars are often sponsored by top insurance companies. Professional associations, such as the Independent Automotive Damage Appraisers Association, also offer annual conferences. At these workshops, claims examiners learn about new federal and state requirements and any court decisions that might affect insurance policies and procedures. These professional seminars sometimes comply with state-mandated continuing education requirements for claims examiners.

Additional Professional Development

Some technical schools and colleges offer online certificates in claims examining. These programs are geared toward aspiring claims examiners, as well as those already employed in the field.

The International Claim Association also offers education programs in Associate, Life and Health Claims (ALHC) and Fellow, Life and Health Claims (FLHC). Students in these programs complete a series of courses and exams and are awarded a diploma and either the ALHC or FLHC professional designation.

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