Claims Examiners, Property & Casualty Insurance
Also called: Claims Adjuster, Claims Examiner, Claims Representative, Claims Specialist
Produced by CareerOneStop
Video transcript: skip transcript
When natural disaster strikes, or a car accident happens, insurance professionals are called in to help start putting the pieces back together. When people have an insurance policy for their health, home, or car, and they become injured or their property is damaged, they make a request —called a claim— for payment to cover their costs. Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims, to decide whether an insurance company must pay a claim, and if so, how much. Appraisers estimate the cost or value of an insured item. Most are auto damage appraisers— they inspect damaged vehicles and estimate the cost of repairs. Adjusters inspect damaged real estate properties and automobiles to determine how much the insurance company should pay for the loss. They gather evidence and report it to examiners. Adjusters negotiate with the policyholder to arrive at a final payment amount for their claim. Claims examiners review claims to ensure guidelines are followed properly. They review health-related claims to determine whether to pay… deny… or refer a claim to an investigator. Insurance investigators handle potentially fraudulent claims or suspected criminal activity such as arson, staged accidents, or unnecessary medical treatments. Claims adjusters, examiners, and investigators spend time in the office, and out in the field to inspect damaged properties. Auto damage appraisers spend much of their time at automotive body shops to estimate repair costs. Entry-level claims adjusters, examiners, and investigators need a high school diploma or equivalent. Auto damage appraisers require either a certificate in the field, or work experience estimating the cost of car repairs.
What they do: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.
On the job, you would:
- 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.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- customer service
Arts and Humanities
- English language
Safety and Government
- law and government
- reading work related information
- writing things for co-workers or customers
- noticing a problem and figuring out the best way to solve it
- bringing people together to solve differences
- understanding people's reactions
- listen and understand what people say
- read and understand what is written
Ideas and Logic
- use rules to solve problems
- notice when problems happen
People interested in this work like activities that include data, detail, and regular routines.
They do well at jobs that need:
- Attention to Detail
- Stress Tolerance
- Self Control
You might use software like this on the job:
Document management software
- Agency Management Systems AMS 360
- BCCORP W5 for Adjusters
Expert system software
- Axonwave Fraud and Abuse Management System
- Bill review software