What is a claims examiner?

A claims examiner evaluates claim files that have been submitted by an insurance adjuster. They decide whether to authorize or deny payments and refer suspicious or complicated claims to insurance investigators. This job is a risk management position. In health insurance, examiners may have to decide if medical procedures are worth the patient’s prognosis, if someone's cause of death warrants incidental fees, or if witness interviews waive the insurance company’s liability.