Claims examiner: meaning, definitions and examples

Typically used in the context of reviewing insurance claims to ensure compliance with company policies and legal requirements. They often work in office settings and may not conduct extensive fieldwork.

• The claims examiner carefully reviewed the paperwork to determine if the claim was valid.
• After receiving additional documentation, the claims examiner approved the customer’s claim.

Often used for professionals who investigate insurance claims by interviewing the claimant and witnesses, inspecting property damage, and reviewing documents. They commonly perform fieldwork and interact directly with claimants.

• The claims adjuster visited the site of the accident to assess the damage first-hand.
• After speaking with witnesses and inspecting the car, the claims adjuster determined the extent of the insurance payout.

Used in situations where verification or suspicion of fraudulent claims is involved. They perform detailed investigations, including surveillance and background checks, to detect possible fraud.

• Suspecting fraud, the insurance investigator conducted a thorough investigation of the claimant's background.
• The insurance investigator spent weeks tracking the suspect's activities to gather evidence of false claims.