A claims auditor helps an insurance company reduce operational losses resulting from policyholder fraud or deceit. She reviews requests for reimbursement that an insurer receives and ensures that such requests are valid. A claims auditor typically holds a four-year college degree in a business field and works in the audit or compliance departments.
A claims auditor ensures that policyholder claims, or requests for reimbursement, are valid and accurate. He reviews policyholder requests and applies generally accepted auditing standards (GAAS) to confirm correctness of claim amounts, the occurrence of the adverse event leading to the claim and the policyholder's eligibility. For instance, an auditor reviews a car insurance policyholder's request for reimbursement. She ensures that the policy is still in-force (active) and the accident occurred on the specified date.
Education and Training
A claims auditor generally has a four-year college degree in auditing, finance or accounting. A claims auditor with major supervisory duties may hold a master's degree in a business field. A claims auditing specialist with prior public accounting experience generally has a certified public accountant (CPA) license.
A claims auditor's total compensation depends on seniority and length of service. Other factors, including the firm's location and the claims auditor's professional or academic credentials, also affect his compensation levels. According to the U.S. Bureau of Labor Statistics, claims auditor trainees earned median annual wages of $32,510 in 2008, with the top 10 percent earning more than $49,260 and the bottom 10 percent earning less than $20,950. An experienced and skilled professional earns more. The same research indicates that claims auditors earned average annual salaries of $59,430 in 2008, with the bottom 10 percent of the profession earning less than $36,720 and the top 10 percent earning more than $102,380.
A claims auditor who wants to advance in the field can seek a higher academic degree or a professional designation. To illustrate, a claims auditor with a bachelor's degree could enroll in a university's graduate program in auditing, and graduate; she also may seek a CPA license. A competent and effective claims auditor may move to a higher role, such as senior claims auditor or claims audit supervisor, within two to five years.
A claims auditor's schedule depends on business conditions. He typically has a standard 8:30 a.m. to 5:30 p.m. work shift. He may, however, work late nights, early mornings or on weekends if required. For instance, a claims auditor working for a large insurance company may be busy at the end of the quarter to help the firm file statutory reports with a state's insurance department.