Claims Adjusters, Examiners, and Investigators

Three MBA students discuss business adminstration jobs
$75,050 Median Wage (2023)
20,900 Projected job openings (2023-2033)
-4.4% Projected growth (2023-2033)

Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.

Experience Requirements Overview

  • Job Zone Four: Considerable Preparation Needed
  • A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
  • Most of these occupations require a four-year bachelor's degree, but some do not.
  • Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.

Education, Training and Experience

Required Level of Education: Bachelor's Degree

Related Work Experience: Over 2 years, up to and including 4 years

On-Site or In-Plant Training: Over 6 months, up to and including 1 year

On-the-Job Training: Over 6 months, up to and including 1 year

Detailed Work Activities

  • Calculate data to inform organizational operations.
  • Investigate legal issues.
  • Prepare legal or investigatory documentation.
  • Estimate costs of goods or services.
  • Appraise property values.

Work Values

Achievement

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.

Working Conditions

Recognition

Relationships

Support

Independence

Tasks

  • Examine claims forms and other records to determine insurance coverage.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Pay and process claims within designated authority level.
  • Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Investigate and assess damage to property and create or review property damage estimates.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Confer with legal counsel on claims requiring litigation.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Collect evidence to support contested claims in court.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Present cases and participate in their discussion at claim committee meetings.
  • Report overpayments, underpayments, and other irregularities.
  • Attend mediations or trials.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.
  • Obtain credit information from banks and other credit services.
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.

Work Styles

Achievement/Effort

Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.

Persistence

Initiative

Leadership

Cooperation

Concern for Others

Social Orientation

Self-Control

Stress Tolerance

Adaptability/Flexibility

Dependability

Attention to Detail

Integrity

Independence

Innovation

Analytical Thinking

Data Source: This page includes information from the O*NET 28.0 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license. O*NET® is a trademark of USDOL/ETA. This page includes Employment Projections program, Occupational Employment and Wage Statistics program, U.S. Bureau of Labor Statistics.