DISABILITY EXAMINER SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

Updated: Mai 28, 2025 - The Disability Examiner demonstrates advanced claim management expertise across multiple areas, including liability, property, and automobile claims, with a solid understanding of tort law and insurance policies. This position applies critical thinking and creative problem-solving to resolve complex claim issues while ensuring superior outcomes and cost management. The examiner excels in communication, negotiation, and conflict resolution with a detail-oriented and organized approach to claim handling.

Essential Hard and Soft Skills for a Standout Disability Examiner Resume
  • Medical Terminology
  • Disability Laws and Regulations
  • Medical Record Review
  • Data Analysis
  • Report Writing
  • Claim Processing
  • Knowledge of Diagnostic Codes
  • Computer Proficiency
  • Data Entry
  • Case Management
  • Attention to Detail
  • Communication
  • Critical Thinking
  • Problem Solving
  • Empathy
  • Time Management
  • Organization
  • Decision Making
  • Teamwork
  • Adaptability

Summary of Disability Examiner Knowledge and Qualifications on Resume

1. BS in Public Health with 1 year of Experience

  • Work experience in claims processing or caseload management.
  • Solid written communication skills to write clearly and organize material logically for inclusion in correspondence and documentation of decisions.
  • Proficient in English language reading/writing skills sufficient to clearly and accurately understand and communicate information.
  • High-level reading comprehension and analysis skills to understand, apply, and interpret laws, rules, regulations, policies, and procedures.
  • Strong decision-making skills to make accurate and sound determinations on eligibility following laws, rules, regulations, policies, and procedures.
  • Ability to organize and prioritize work, including case files, and multi-task in dealing with multiple cases at one time.
  • Knowledge of medical terminology and medical assessments.
  • Experience working in Telephone Customer Service
  • Proficiency in computer use and use of various office software (e.g. Microsoft Word, Excel), email programs (e.g. Outlook), and other database applications.
  • The ability to work independently with excellent interpersonal skills

2. BS in Nursing with 4 years of Experience

  • Previous claims processing/adjudication experience
  • Ability to read and interpret medical policies to determine claim eligibility
  • Detail-oriented and able to make decisions based on information provided
  • Strong analytical and decision-making skills
  • Knowledge of CPT, HCPC ICD-10 codes
  • Knowledge of COBRA, HIPPA, pre-existing conditions, and coordination of benefits
  • Must possess the ability to learn quickly
  • Proficient in using Microsoft Windows 365, Word, and Excel
  • Highly motivated, strong work ethic, and team player
  • Good communication skills both written and oral
  • Ability to work independently with limited supervision

3. BS in Medical Laboratory Science with 6 years of Experience

  • Highly technical claim management skills
  • Significant knowledge of and experience with more than one of the following - Employment Practices Liability, Social Service Professional, Sexual Abuse, General Liability, and/ or Automobile
  • Demonstrates expertise in Property claims management as stand-alone expertise in the Property area.
  • A thorough knowledge of current tort law and case law trends concerning all casualty lines of business, civil procedure, insurance policies, and contracts.
  • Must demonstrate good written and oral communication skills
  • Be organized, and have strong follow-up skills.
  • The ability to analyze and apply creative solutions to claim issues.
  • Proven critical thinking skills that demonstrate analysis/judgment and sound decision-making with a focus on attention to details
  • Strong negotiating skills, and excellent telephone, written, and verbal communication skills
  • Possesses and regularly demonstrates objectivity and pragmatism as well as strong conflict-resolution skills
  • Ability to manage total loss cost outcomes including ALAE to achieve superior results for members and the company

4. BS in Health Information Management with 5 years of Experience

  • Medical claims payment experience in an HMO environment (i.e. MSO, IPA, or health plan)
  • Strong knowledge of Medicare and Medi-Cal managed care claims processing and compliance guidelines.
  • Experience with CPT-4, ICD-9CM, ICD-10CM, RBRVS, ASA, and HCPCS
  • An in-depth understanding of Medicare and Medi-Cal guidelines that apply to COB and Medicare Secondary Payers.
  • Working knowledge of reimbursement methodologies of professional claims including injectable drugs.
  • Must be detail-oriented, attentive, organized, and able to follow directions.
  • Ability to work independently utilizing company-established processes.
  • Ability to meet deadlines and maintain department quality standards.
  • Ability to interact well with providers calling regarding claim status.
  • Ability to interact well with fellow employees and supervisors and be a team player.
  • Strong work ethic and professionalism.
  • Intermediate computer skills including Microsoft Word, Excel, and Internet navigation.
Relevant Information
Disability Case Manager Skills, Experience, and Job Requirements