| Claims Examiner III |
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| Also referred to as: Claim Review and Settlement Examiner III, Insurance Claims Examiner III |
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| Requirements and Responsibilities |
| Examines and adjudicates insurance claims to determine coverage, validity, and appropriate payment in accordance with policy terms and regulations. Reviews claim documentation, policy provisions, and supporting evidence to assess liability and exposure. Authorizes claim payments within established authority limits. Investigates questionable or complex claims and coordinates with adjusters, providers, or external parties as needed. Documents findings, decisions, and rationale clearly within the claims system. Ensures compliance with company guidelines, regulatory requirements, and service standards. Requires a bachelor's degree. Typically reports to a manager. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4-7 years of related experience. |
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| Similar Jobs: Disability Claims Examiner III, Claims Examiner I, Claims Examiner II, Claims Examiner IV, Claims Adjuster III - P&C, Claims Clerk III, Disability Claims Examiner II, Disability Claims Examiner I, Medical Claims Examiner II |
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| Level of Education: Claims Examiner III Salaries with No Diploma, Claims Examiner III Salaries with a High School Diploma or Technical Certificate, Claims Examiner III Salaries with an Associate's Degree, Claims Examiner III Salaries with a Bachelor's Degree, Claims Examiner III Salaries with a Master's Degree or MBA, Claims Examiner III Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Energy & Utilities, Financial Services, Healthcare, Insurance, MFG Nondurable, Retail & Wholesale, Transportation | |
