What does a liability claims examiner do?
A Liability Claims Examiner or also known as an Insurance investigator, is a person who monitors and reviews settled insurances. They will determine if the paid amount is in accordance with the corporation or company's procedure. They report possible irregularities that are happening, like underpayment and overpayment of insurances. They also evaluate insurance claims or applications and do a follow-up of the status to protect and secure the clients from having a financial loss.
Liability claims examiner responsibilities
Here are examples of responsibilities from real liability claims examiner resumes:
- Handle automobile liability, general liability, products liability and manage litigation for one specific client.
- Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
- Oversee adjustment of all third-party liability losses, coverage assessment, investigation, and evaluations regarding litigation claims.
- Mentore less experience and newer employees in career development and individual development plans to facilitate future leadership candidates for the enterprise.
- Interact with assign counsel for case status, interrogatories and preparation for trials on calendar.
- Investigate and identify fraud claims and partner with SIU for additional investigations to prevent payouts after fraud are proven.
- Monitor activities in order to identify possible fraud and/or abuse and refer those cases as needed to the SIU department.
- Defend liability and coverage decisions through arbitration.
- Maintain disability files with pertinent client information according to HIPAA privacy rules throughout the disability process.
Liability claims examiner skills and personality traits
We calculated that 12% of Liability Claims Examiners are proficient in Party Claims, Litigation, and Claims Handling. They’re also known for soft skills such as Analytical skills, Communication skills, and Detail oriented.
We break down the percentage of Liability Claims Examiners that have these skills listed on their resume here:
- Party Claims, 12%
Manage 3rd party claims for Yellow Taxis, Livery Cars and Luxury vehicles.
- Litigation, 12%
Handled automobile liability, general liability, products liability and managed litigation for one specific client.
- Claims Handling, 11%
Provide customer service to policyholders through professional claims handling.
- Claims Process, 11%
Corresponded with attorneys, claimants and other carriers throughout claims process.
- Policy Coverage, 10%
Determined proper policy coverage, and where necessary, investigated, evaluated, negotiated and settled all assigned liability claims cases.
- Coverage Analysis, 9%
Documented coverage analysis and finalized liability for multi vehicle losses fairly in time sensitive reports.
Most liability claims examiners use their skills in "party claims," "litigation," and "claims handling" to do their jobs. You can find more detail on essential liability claims examiner responsibilities here:
Analytical skills. One of the key soft skills for a liability claims examiner to have is analytical skills. You can see how this relates to what liability claims examiners do because "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." Additionally, a liability claims examiner resume shows how liability claims examiners use analytical skills: "negotiated settlements on complex claims and prepared data for litigation. "
Communication skills. Another essential skill to perform liability claims examiner duties is communication skills. Liability claims examiners responsibilities require that "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." Liability claims examiners also use communication skills in their role according to a real resume snippet: "negotiated with other insurance carriers using various communication channels. "
Detail oriented. This is an important skill for liability claims examiners to perform their duties. For an example of how liability claims examiner responsibilities depend on this skill, consider that "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a liability claims examiner: "conduct necessary investigations to determine policy coverage and details of the loss. ".
Interpersonal skills. liability claims examiner responsibilities often require "interpersonal skills." The duties that rely on this skill are shown by the fact that "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." This resume example shows what liability claims examiners do with interpersonal skills on a typical day: "supported and coached new team members on meeting objectives, call monitoring, and effective interpersonal skills for exceptional customer service. "
The three companies that hire the most liability claims examiners are:
- Sedgwick LLP228 liability claims examiners jobs
- The Jonus Group5 liability claims examiners jobs
- Crawford & Company4 liability claims examiners jobs
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Liability claims examiner vs. Claim specialist
A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.
While similarities exist, there are also some differences between liability claims examiners and claim specialist. For instance, liability claims examiner responsibilities require skills such as "calculates," "claims process," "coverage analysis," and "resolves claims." Whereas a claim specialist is skilled in "patients," "quality standards," "excellent organizational," and "medical terminology." This is part of what separates the two careers.
Claim specialists really shine in the insurance industry with an average salary of $56,779. Comparatively, liability claims examiners tend to make the most money in the insurance industry with an average salary of $62,061.claim specialists tend to reach similar levels of education than liability claims examiners. In fact, claim specialists are 1.6% less likely to graduate with a Master's Degree and 2.4% less likely to have a Doctoral Degree.Liability claims examiner vs. Claim processor
A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed. Moreover, it is also the task of the Claims Processor to prepare the necessary documents and guidelines for the policyholder, process reimbursements upon approval, provide answers to inquiries, and report issues and updates to the management.
Each career also uses different skills, according to real liability claims examiner resumes. While liability claims examiner responsibilities can utilize skills like "party claims," "calculates," "litigation," and "claims process," claim processors use skills like "data entry," "medical terminology," "cpt," and "claims processing."
On average, claim processors earn a lower salary than liability claims examiners. Some industries support higher salaries in each profession. Interestingly enough, claim processors earn the most pay in the insurance industry with an average salary of $47,078. Whereas liability claims examiners have higher pay in the insurance industry, with an average salary of $62,061.claim processors earn similar levels of education than liability claims examiners in general. They're 2.7% less likely to graduate with a Master's Degree and 2.4% less likely to earn a Doctoral Degree.Liability claims examiner vs. Claims benefit specialist
Claims and benefits specialists ensure their company's compliance with the internal and external health plan partner processes. The job requires them to be sharp, organized, and able to multitask. They recommend strategies that will improve the processes present in the current trends that they constantly evaluate. These specialists manage portfolios of claims and benefits issues and ensure that they provide the best resolutions that follow the health plan processing guidelines to impress their clients.
The required skills of the two careers differ considerably. For example, liability claims examiners are more likely to have skills like "party claims," "calculates," "litigation," and "claims process." But a claims benefit specialist is more likely to have skills like "customer inquiries," "appeals," "medical terminology," and "routine claims."
Most claims benefit specialists achieve a similar degree level compared to liability claims examiners. For example, they're 4.1% less likely to graduate with a Master's Degree, and 3.5% less likely to earn a Doctoral Degree.Liability claims examiner vs. Claims analyst
A claims analyst specializes in processing medical insurance claims. They are primarily responsible for verifying the authenticity and eligibility of claims, analyzing the billing, communicating with policyholders, and ensuring adherence to all the policies and regulations during the entire procedure. Furthermore, a claims analyst is also in charge of administrative tasks such as keeping and updating records, reaching out and sending reports to creditors, setting appointments and schedules, processing paperwork, coordinating with key personnel, and discussing terms and necessary information to clients.
Types of liability claims examiner
Updated January 8, 2025
