How to Be Insurance Examiner - Job Description, Skills, and Interview Questions

Dec 30, 2020 / 4 Minutes Read / By Albert

How to Become

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The increasing number of uninsured drivers on the roads has had a significant impact on the insurance industry. This has caused insurance companies to raise rates in order to cover potential losses from uninsured drivers and to cover their own costs. As a result, insurance examiners have seen an increase in the amount of work required to assess the risk factors for each policy holder, to ensure that they are appropriately charged for the coverage they need. Additionally, insurance examiners must also be diligent in their efforts to verify the accuracy of the data provided by policy holders, such as proof of identity and income, in order to properly assess risk.

Steps How to Become

Earn a Bachelor's Degree. Insurance examiners typically need a bachelor's degree in business, finance, accounting, economics, or a related field.
Obtain Relevant Experience. Employers typically prefer candidates who have work experience in the insurance industry. Internships and entry-level positions can provide valuable experience.
Obtain Licenses and Certifications. Most states require insurance examiners to obtain one or more licenses and certifications before they can begin working.
Join Professional Organizations. Joining professional organizations can help insurance examiners stay up to date on changes in the field and network with other professionals.
Work as an Insurance Examiner. Insurance examiners typically work full-time in an office setting. They may also travel to conduct on-site reviews of insurance companies.

The rise in healthcare costs has led to an increased demand for insurance coverage, creating a shortage of qualified and competent insurance examiners. This lack of availability has resulted in higher premiums for consumers, as the cost of hiring and training these professionals can be high. without adequate examiners, discrepancies in coverage and claims can occur, leading to confusion and unnecessary delays in reimbursement.

Furthermore, the increased cost of insurance has caused employers to cut back on benefits, leaving many workers without adequate coverage. As a result, more people are left uninsured or underinsured, exacerbating the already-existing healthcare crisis.

You may want to check Insurance Compliance Officer, Reinsurance Accountant, and Underwriting Supervisor for alternative.

Job Description

Analyze insurance claims for accuracy and compliance with applicable laws and regulations.
Investigate suspicious or questionable claims to determine legitimacy.
Review insurance applications for completeness and accuracy.
Interview claimants and other parties to gather information relevant to insurance claims.
Interpret policy language to ensure claims are properly assessed and adjudicated.
Maintain accurate records of claim investigations and evaluations.
Prepare detailed reports of findings and recommendations.
Work with other departments, such as legal and underwriting, to resolve complex claims issues.
Monitor claims trends to identify opportunities for improvement.
Develop strategies to reduce the likelihood of fraudulent claims.

Skills and Competencies to Have

Knowledge of insurance laws and regulations.
Ability to analyze complex financial and statistical information.
Ability to accurately assess risk.
Strong research and investigative skills.
Excellent communication and interpersonal skills.
Excellent organizational and time-management skills.
Knowledge of accounting principles and practices.
Proficient in using computers and other data processing systems.
Ability to work independently as well as collaboratively with others.
Demonstrated customer service skills.

Good communication skills are essential for a successful Insurance Examiner. Insurance Examiners need to be able to clearly explain complex coverage policies to clients, as well as effectively explain their findings. They also need to be able to understand and analyze information from multiple sources, such as insurance documents and medical records.

Strong analytical skills are necessary to properly review claims and determine the best course of action. Insurance Examiners must be able to work well with people from various backgrounds and be able to build relationships of trust with clients. Finally, having excellent organizational skills is important to ensure that all information is collected and reviewed in an efficient and timely manner.

In sum, Insurance Examiners must be adept in the areas of communication, analysis, interpersonal relations, and organization to be successful in their roles.

Insurance Marketing Representative, Marine Insurance Agent, and Insurance Risk Manager are related jobs you may like.

Frequent Interview Questions

What experience do you have in the insurance industry?
What challenges have you encountered while working as an insurance examiner?
How do you maintain accurate records of insurance policies and claims?
How do you stay up to date with regulations and changes in the insurance industry?
Describe a situation where you had to make a difficult decision while working as an insurance examiner.
What strategies do you use to investigate potential fraud cases?
What methods do you use to ensure compliance with applicable laws and regulations?
How do you handle challenging conversations with policyholders and claimants?
How do you remain organized when managing multiple cases at once?
Describe your experience training or mentoring new insurance examiners.

Common Tools in Industry

Excel. Excel is an electronic spreadsheet program used to store, organize, and manipulate data. (Eg: Creating a budget spreadsheet)
Database software. Database software allows users to store, organize, and access large amounts of data. (Eg: Storing customer information for insurance policy management)
Calculation software. Calculation software is used to quickly and accurately calculate complex mathematical problems. (Eg: Calculating premium rates for different policies)
Document-editing software. Document-editing software is used to create, edit, and format written documents. (Eg: Writing reports on insurance claims)
Reporting software. Reporting software is used to generate reports and analyze data. (Eg: Generating reports on claims processing times)
Presentation software. Presentation software is used to create and deliver multimedia presentations. (Eg: Presenting findings from an insurance investigation)
Data visualization software. Data visualization software is used to visualize and analyze data. (Eg: Creating graphs to illustrate trends in claims data)
Financial analysis software. Financial analysis software is used to analyze financial data and make predictions. (Eg: Analyzing projected costs of policies)
Risk analysis software. Risk analysis software is used to identify and assess risk factors associated with insurance policies. (Eg: Assessing the risk of a particular policy)
Insurance policy management software. Insurance policy management software is used to manage and track insurance policies. (Eg: Tracking changes in policyholders' coverage)

Professional Organizations to Know

American Association of Insurance Examiners (AAIE)
National Association of Insurance Commissioners (NAIC)
Insurance Regulatory Examiners Society (IRES)
Professional Liability Underwriting Society (PLUS)
The Institutes RiskStream Collaborative
Society of Actuaries (SOA)
Chartered Property Casualty Underwriters (CPCU)
Casualty Actuarial Society (CAS)
Insurance Accounting & Systems Association (IASA)
International Association of Insurance Professionals (IAIP)

We also have Insurance Loss Control Specialist, Claims Examiner, and Claims Manager jobs reports.

Common Important Terms

Actuarial Science. The use of mathematics, statistics, and financial theory to assess risk and uncertainty, and determine premiums and policy rates for insurance companies.
Underwriting. The process of assessing risk and determining the cost of insuring a person or property.
Insurance Claim. A request for payment from an insurance company made by an individual or business that has experienced a loss covered by their insurance policy.
Risk Management. The process of analyzing and mitigating risks associated with an individual or business to protect them from financial losses.
Reinsurance. Insurance that is purchased by an insurance company to help reduce their risk exposure and financial losses.
Loss Ratio. The ratio of total claims paid out by an insurance company to the total premiums collected by the company.
Premium. The amount of money paid by an individual or business to an insurance company in exchange for coverage under an insurance policy.

Frequently Asked Questions

What is an Insurance Examiner?

An Insurance Examiner is a professional who assesses the financial condition of an insurance company to ensure compliance with state and federal regulations. They review financial documents, analyze claims data, and inspect company operations to provide an evaluation of the company's financial stability.