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TITLE: Claims Examiners, Property and Casualty Insurance
DEFINITION: Review settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.
1. Analyzes data used in settling claim to determine its validity in payment of claims.
2. Reports overpayments, underpayments, and other irregularities.
3. Confers with legal counsel on claims requiring litigation.
Knowledge elements are ranked by importance.
Knowledge of numbers, their operations, and interrelationships including arithmetic, algebra, geometry, calculus, statistics, and their applications
54 Law, Government and Jurisprudence
Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process
42 English Language
Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar
29 Communications and Media
Knowledge of media production, communication, and dissemination techniques and methods including alternative ways to inform and entertain via written, oral, and visual media
29 Economics and Accounting
Knowledge of economic and accounting principles and practices, the financial markets, banking, and the analysis and reporting of financial data
29 Administration and Management
Knowledge of principles and processes involved in business and organizational planning, coordination, and execution. This includes strategic planning, resource allocation, manpower modeling, leadership techniques, and production methods
29 Computers and Electronics
Knowledge of electric circuit boards, processors, chips, and computer hardware and software, including applications and programming
Knowledge of administrative and clerical procedures and systems such as word processing systems, filing and records management systems, stenography and transcription, forms design principles, and other office procedures and terminology
17 Public Safety and Security
Knowledge of weaponry, public safety, and security operations, rules, regulations, precautions, prevention, and the protection of people, data, and property
13 Medicine and Dentistry
Knowledge of the information and techniques needed to diagnose and treat injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures
13 Building and Construction
Knowledge of materials, methods, and the appropriate tools to construct objects, structures, and buildings
Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including their relative costs, advantages, and limitations
Knowledge of machines and tools, including their designs, uses, benefits, repair, and maintenance
8 Therapy and Counseling
Knowledge of information and techniques needed to rehabilitate physical and mental ailments and to provide career guidance including alternative treatments, rehabilitation equipment and its proper use, and methods to evaluate treatment effects
Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems
Knowledge of design techniques, principles, tools and instruments involved in the production and use of precision technical plans, blueprints, drawings, and models
4 Customer and Personal Service
Knowledge of principles and processes for providing customer and personal services including needs assessment techniques, quality service standards, alternative delivery systems, and customer satisfaction evaluation techniques
Skills elements are ranked by importance.
79 Problem Identification
Identifying the nature of problems
75 Reading Comprehension
Understanding written sentences and paragraphs in work related documents
Using mathematics to solve problems
71 Information Gathering
Knowing how to find information and identifying essential information
67 Solution Appraisal
Observing and evaluating the outcomes of a problem solution to identify lessons learned or redirect efforts
Talking to others to effectively convey information
Communicating effectively with others in writing as indicated by the needs of the audience
63 Critical Thinking
Using logic and analysis to identify the strengths and weaknesses of different approaches
63 Product Inspection
Inspecting and evaluating the quality of products
58 Active Listening
Listening to what other people are saying and asking questions as appropriate
58 Judgment and Decision Making
Weighing the relative costs and benefits of a potential action
Assessing how well one is doing when learning or doing something
50 Information Organization
Finding ways to structure or classify multiple pieces of information
42 Active Learning
Working with new material or information to grasp its implications
42 Systems Evaluation
Looking at many indicators of system performance, taking into account their accuracy
Reorganizing information to get a better approach to problems or tasks
38 Systems Perception
Determining when important changes have occurred in a system or are likely to occur
Developing an image of how a system should work under ideal conditions
38 Identification of Key Causes
Identifying the things that must be changed to achieve a goal
29 Idea Evaluation
Evaluating the likely success of an idea in relation to the demands of the situation
25 Identifying Downstream Consequences
Determining the long-term outcomes of a change in operations
25 Time Management
Managing one's own time and the time of others
Persuading others to approach things differently
Adjusting actions in relation to others' actions
21 Learning Strategies
Using multiple approaches when learning or teaching new things
Bringing others together and trying to reconcile differences
21 Idea Generation
Generating a number of different approaches to problems
Using scientific methods to solve problems
17 Social Perceptiveness
Being aware of others' reactions and understanding why they react the way they do
17 Implementation Planning
Developing approaches for implementing an idea
13 Management of Material Resources
Obtaining and seeing to the appropriate use of equipment, facilities, and materials needed to do certain work
Determining what is causing an operating error and deciding what to do about it
8 Management of Financial Resources
Determining how money will be spent to get the work done, and accounting for these expenditures
4 Management of Personnel Resources
Motivating, developing, and directing people as they work, identifying the best people for the job
4 Service Orientation
Actively looking for ways to help people
4 Operations Analysis
Analyzing needs and product requirements to create a design
4 Operation and Control
Controlling operations of equipment or systems
Teaching others how to do something .
Abilities elements are ranked by importance.
75 Written Comprehension
The ability to read and understand information and ideas presented in writing
70 Mathematical Reasoning
The ability to understand and organize a problem and then to select a mathematical method or formula to solve the problem
65 Number Facility
The ability to add, subtract, multiply, or divide quickly and correctly
65 Problem Sensitivity
The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
60 Oral Comprehension
The ability to listen to and understand information and ideas presented through spoken words and sentences
60 Written Expression
The ability to communicate information and ideas in writing so others will understand
55 Oral Expression
The ability to communicate information and ideas in speaking so others will understand
50 Deductive Reasoning
The ability to apply general rules to specific problems to come up with logical answers. It involves deciding if an answer makes sense.
45 Near Vision
The ability to see details of objects at a close range (within a few feet of the observer)
40 Speech Clarity
The ability to speak clearly so that it is understandable to a listener
25 Inductive Reasoning
The ability to combine separate pieces of information, or specific answers to problems, to form general rules or conclusions. It includes coming up with a logical explanation for why a series of seemingly unrelated events occur together.
25 Information Ordering
The ability to correctly follow a given rule or set of rules in order to arrange things or actions in a certain order. The things or actions can include numbers, letters, words, pictures, procedures, sentences, and mathematical or logical operations.
20 Speech Recognition
The ability to identify and understand the speech of another person
20 Trunk Strength
The ability to use one's abdominal and lower back muscles to support part of the body repeatedly or continuously over time without "giving out" or fatiguing
20 Selective Attention
The ability to concentrate and not be distracted while performing a task over a period of time
15 Wrist-Finger Speed
The ability to make fast, simple, repeated movements of the fingers, hands, and wrists
15 Perceptual Speed
The ability to quickly and accurately compare letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object
10 Time Sharing
The ability to efficiently shift back and forth between two or more activities or sources of information (such as speech, sounds, touch, or other sources)
10 Finger Dexterity
The ability to make precisely coordinated movements of the fingers of one or both hands to grasp, manipulate, or assemble very small objects
10 Extent Flexibility
The ability to bend, stretch, twist, or reach out with the body, arms, and/or legs
10 Fluency of Ideas
The ability to come up with a number of ideas about a given topic. It concerns the number of ideas produced and not the quality, correctness, or creativity of the ideas.
10 Glare Sensitivity
The ability to see objects in the presence of glare or bright lighting
10 Hearing Sensitivity
The ability to detect or tell the difference between sounds that vary over broad ranges of pitch and loudness
The ability to imagine how something will look after it is moved around or when its parts are moved or rearranged
5 Flexibility of Closure
The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material
5 Arm-Hand Steadiness
The ability to keep the hand and arm steady while making an arm movement or while holding the arm and hand in one position
5 Manual Dexterity
The ability to quickly make coordinated movements of one hand, a hand together with its arm, or two hands to grasp, manipulate, or assemble objects
5 Speed of Closure
The ability to quickly make sense of information that seems to be without meaning or organization. It involves quickly combining and organizing different pieces of information into a meaningful pattern
5 Spatial Orientation
The ability to know one's location in relation to the environment, or to know where other objects are in relation to one's self
5 Rate Control
The ability to time the adjustments of a movement or equipment control in anticipation of changes in the speed and/or direction of a continuously moving object or scene
5 Reaction Time
The ability to quickly respond (with the hand, finger, or foot) to one signal (sound, light, picture, etc.) when it appears
The ability to remember information such as words, numbers, pictures, and procedures
5 Static Strength
The ability to exert maximum muscle force to lift, push, pull, or carry objects
5 Multilimb Coordination
The ability to coordinate movements of two or more limbs together (for example, two arms, two legs, or one leg and one arm) while sitting, standing, or lying down. It does not involve performing the activities while the body is in motion
5 Gross Body Coordination
The ability to coordinate the movement of the arms, legs, and torso together in activities where the whole body is in motion
5 Far Vision
The ability to see details at a distance
The ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem
5 Auditory Attention
The ability to focus on a single source of auditory (hearing) information in the presence of other distracting sounds
Work activities elements are ranked by importance.
92 Evaluating Information Against Standards
Evaluating information against a set of standards and verifying that it is correct.
75 Analyzing Data or Information
Identifying underlying principles, reasons, or facts by breaking down information or data into separate parts.
71 Judging Qualities of Things, Services, or People
Making judgments about or assessing the value, importance, or quality of things or people.
67 Getting Information Needed to Do the Job
Observing, receiving, and otherwise obtaining information from all relevant sources.
58 Making Decisions and Solving Problems
Combining, evaluating, and reasoning with information and data to make decisions and solve problems. These processes involve making decisions about the relative importance of information and choosing the best solution.
50 Communicating With Other Workers
Providing information to supervisors, fellow workers, and subordinates. This information can be exchanged face-to-face, in writing, or via telephone/electronic transfer.
42 Processing Information
Compiling, coding, categorizing, calculating, tabulating, auditing, verifying, or processing information or data.
42 Communicating With Persons Outside Organization
Communicating with persons outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged face-to-face, in writing, or via telephone/electronic transfer.
38 Documenting or Recording Information
Entering, transcribing, recording, storing, or maintaining information in either written form or by electronic/magnetic recording.
38 Updating and Using Job-Relevant Knowledge
Keeping up-to-date technically and knowing one's own jobs' and related jobs' functions.
38 Identifying Objects, Actions, and Events
Identifying information received by making estimates or categorizations, recognizing differences or similarities, or sensing changes in circumstances or events.
33 Organizing, Planning, and Prioritizing
Developing plans to accomplish work, and prioritizing and organizing one's own work.
33 Interacting With Computers
Controlling computer functions by using programs, setting up functions, writing software, or otherwise communicating with computer systems.
33 Performing Administrative Activities
Approving requests, handling paperwork, and performing day-to-day administrative tasks.
33 Interpreting Meaning of Information to Others
Translating or explaining what information means and how it can be understood or used to support responses or feedback to others.
29 Providing Consultation and Advice to Others
Providing consultation and expert advice to management or other groups on technical, systems-related, or process related topics.
25 Monitor Processes, Material, or Surroundings
Monitoring and reviewing information from materials, events, or the environment, often to detect problems or to find out when things are finished.
21 Implementing Ideas or Programs
Conducting or carrying out work procedures and activities in accord with one's own ideas or information provided through directions/instructions for purposes of installing, modifying, preparing, delivering, constructing, integrating, finishing, or completing programs, systems, structures, or products.
21 Estimating Needed Characteristics
Estimating the Characteristics of Materials, Products, Events, or Information: Estimating sizes, distances, and quantities, or determining time, costs, resources, or materials needed to perform a work activity.
17 Establishing and Maintaining Relationships
Developing constructive and cooperative working relationships with others.
17 Handling and Moving Objects
Using one's own hands and arms in handling, installing, forming, positioning, and moving materials, or in manipulating things, including the use of keyboards.
13 Assisting and Caring for Others
Providing assistance or personal care to others.
8 Coordinating Work and Activities of Others
Coordinating members of a work group to accomplish tasks.
8 Selling or Influencing Others
Convincing others to buy merchandise/goods, or otherwise changing their minds or actions.
8 Controlling Machines and Processes
Using either control mechanisms or direct physical activity to operate machines or processes (not including computers or vehicles).
8 Teaching Others
Identifying educational needs, developing formal training programs or classes, and teaching or instructing others.
4 Developing Objectives and Strategies
Establishing long range objectives and specifying the strategies and actions to achieve these objectives.
4 Inspecting Equipment, Structures, or Material
Inspecting or diagnosing equipment, structures, or materials to identify the causes of errors or other problems or defects.
4 Thinking Creatively
Originating, inventing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
4 Scheduling Work and Activities
Scheduling events, programs, activities, as well as the work of others.
4 Performing General Physical Activities
Performing physical activities that require moving one's whole body, such as in climbing, lifting, balancing, walking, stooping, where the activities often also require considerable use of the arms and legs, such as in the physical handling of materials.
4 Operating Vehicles or Equipment
Running, maneuvering, navigating, or driving vehicles or mechanized equipment, such as forklifts, passenger vehicles, aircraft, or water craft.
4 Monitoring and Controlling Resources
Monitoring and controlling resources and overseeing the spending of money.
4 Repairing and Maintaining Mechanical Equipment
Fixing, servicing, aligning, setting up, adjusting, and testing machines, devices, moving parts, and equipment that operate primarily on the basis of mechanical (not electronic) principles.
4 Resolving Conflict or Negotiating with Others
Handling complaints, arbitrating disputes, and resolving grievances, or otherwise negotiating with others.
4 Developing and Building Teams
Encouraging and building mutual trust, respect, and cooperation among team members.
4 Coaching and Developing Others
Identifying developmental needs of others and coaching or otherwise helping others to improve their knowledge or skills.
Work context elements are ranked by frequency (F), importance (I), responsibility (R), amount of contact (C), how serious (S), objective vs. subjective (O), automation (A), extent of frustration (E), responsible for health and safety (H), likelihood of injury (L), degree of injury (D) .
95 (F) Indoors
How frequently does this job require the worker to work: Indoors
88 (I) Importance of Being Sure All Is Done
How important is it to be sure that all the details of this job are performed and everything is done completely?
85 (F) Sitting
How much time in a usual work period does the worker spend: Sitting?
76 (I) Importance of Being Exact or Accurate
How important is being very exact or highly accurate in performing this job?
50 (S) Consequence of Error
How serious would the result usually be if the worker made a mistake that was not readily correctable?
45 (F) Frequency in Conflict Situations
How frequently do the job requirements place the worker in conflict situations?
40 (C) Job-Required Social Interaction
How much does this job require the worker to be in contact (face-to-face, by telephone, or otherwise) with others in order to perform it?
35 (F) Deal With Unpleasant or Angry People
How frequently does the worker have to deal with unpleasant, angry, or discourteous individuals as part of the job requirements?
33 (O) Objective or Subjective Information
How objective or subjective is the information communicated in this job?
32 (I) Take a Position Opposed to Others
How important are interactions requiring the worker to: Take a position opposed to coworkers or others?
32 (I) Deal With External Customers
How important are interactions requiring the worker to: Deal with external customers (e.g., retail sales) or the public in general (e.g., police work)?
30 (F) Walking or Running
How much time in a usual work period does the worker spend: Walking or running?
25 (F) Making Repetitive Motions
How much time in a usual work period does the worker spend: Making repetitive motions?
25 (F) Using Hands on Objects, Tools, Controls
How much time in a usual work period does the worker spend: Using hands to handle, control, or feel objects, tools or controls?
24 (I) Importance of Repeating Same Tasks
How important is repeating the same physical activities (e.g., key entry) or mental activities (e.g., checking entries in a ledger) over and over, without stopping, to performing this job?
20 (F) Standing
How much time in a usual work period does the worker spend: Standing?
20 (I) Persuade Someone to a Course of Action
How important are interactions requiring the worker to: Persuade someone to a course of action (informally) or influence others to buy something (to sell)?
20 (I) Provide a Service to Others
How important are interactions requiring the worker to: Provide a service to others (e.g., customers)?
17 (R) Responsibility for Outcomes and Results
How responsible is the worker for work outcomes and results of other workers?
17 (E) Frustrating Circumstances
To what extent do frustrating circumstances ("road blocks" to work that are beyond the worker's control) hinder the accomplishment of this job?
16 (I) Importance of Being Aware of New Events
How important is being constantly aware of either frequently changing events (e.g. security guard watching for shoplifters) or infrequent events (e.g. radar operator watching for tornadoes) to performing this job?
15 (F) Outdoors
How frequently does this job require the worker to work: Outdoors
12 (I) Coordinate or Lead Others
How important are interactions requiring the worker to: Coordinate or lead others in accomplishing work activities (not supervision)?
10 (A) Degree of Automation
Indicate the level of automation of this job.
10 (F) Kneeling, Crouching or Crawling
How much time in a usual work period does the worker spend: Kneeling, stooping, crouching or crawling?
10 (F) Bending or Twisting the Body
How much time in a usual work period does the worker spend: Bending or twisting the body?
5 (F) Keeping or Regaining Balance
How much time in a usual work period does the worker spend: Keeping or regaining balance?
5 (F) Deal With Physically Aggressive People
How frequently does this job require the worker to deal with physical aggression of violent individuals?
4 (I) Supervise, Coach, Train Others
How important are interactions requiring the worker to: Supervise, coach, train, or develop other employees?
Interest elements are ranked by occupational interest.
Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Artistic occupations frequently involve working with forms, designs and patterns. They often require self-expression and the work can be done without following a clear set of rules.
Realistic occupations frequently involve work activities that include practical, hands-on problems and solutions. They often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require working outside, and do not involve a lot of paperwork or working closely with others.
Work values elements are ranked by extent.
71 Support-Mean Extent
Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
60 Working Conditions-Mean Extent
Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
50 Achievement-Mean Extent
Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.
49 Independence-Mean Extent
Occupations that satisfy this work value allow employs to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
48 Recognition-Mean Extent
Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.
45 Relationships-Mean Extent
Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
81 Company Policies and Practices
Workers on this job are treated fairly by the company
78 Supervision, Human Relations
Workers on this job have supervisors who back up their workers with management
75 Working Conditions
Workers on this job have good working conditions
Workers on this job have steady employment
Workers on this job have opportunities for advancement
Workers on this job make decisions on their own
Workers on this job do their work alone
Workers on this job are busy all the time
56 Moral Values
Workers on this job are never pressured to do things that go against their sense of right and wrong
Workers on this job plan their work with little supervision
53 Supervision, Technical
Workers on this job have supervisors who train their workers well
Workers on this job are paid well in comparison with other workers
50 Ability Utilization
Workers on this job make use of their individual abilities
Workers on this job get a feeling of accomplishment
47 Social Status
Workers on this job are looked up to by others in their company and their community
Workers on this job have co-workers who are easy to get along with
Workers on this job receive recognition for the work they do
Workers on this job have something different to do every day
Workers on this job give directions and instructions to others
34 Social Service
Workers on this job have work where they do things for other people
Workers on this job try out their own ideas
|DOT91 (Dictionary of Occupational Titles):||
168267014 Claim Examiner
|AIM97 (Apprenticeship Information Management):||
|CEN90 (1990 Census Occupations):||
036 Inspectors and Compliance Officers, except Construction
|CIP90 (Classification of Instructional Programs):||
520805 Insurance and Risk Management
520801 Finance, General
|GOE93 (Guide for Occupational Exploration):||
070203 Mathematical Detail: Statistical Reporting and Analysis
|MOC97 (Military Occupational Codes):||
|OES98 (Occupational Employment Statistics):||
21921 Claims Examiners, Property and Casualty Insurance
|OPM97 (Office of Personnel Management Occupations):||
1163 Insurance Examining
|SOC98 (Standard Occupational Classification):||
13-1031 Claims Adjusters, Examiners, and Investigators