Insurance Adjusters, Examiners, & Investigators
Also called: Adjuster, Claims Adjuster, Claims Examiner, Claims Representative
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:Investigate, analyze, and determine the extent of insurance company's liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.
On the job, you would:
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- customer service
- administrative services
Arts and Humanities
- English language
Math and Science
- arithmetic, algebra, geometry, calculus, or statistics
Safety and Government
- law and government
- thinking about the pros and cons of different ways to solve a problem
- listening to others, not interrupting, and asking good questions
- noticing a problem and figuring out the best way to solve it
- communicate by speaking
- listen and understand what people say
Ideas and Logic
- make general rules or come up with answers from lots of detailed information
- use rules to solve problems
- add, subtract, multiply, or divide
- choose the right type of math to solve a problem
- see hidden patterns
People interested in this work like activities that include data, detail, and regular routines.
They do well at jobs that need:
- Self Control
- Attention to Detail
- Stress Tolerance
You might use software like this on the job:
Document management software
- Agency Management Systems AMS 360
- Automatic Data Processing Claims Manager & Dispatch
Expert system software
- Axonwave Fraud and Abuse Management System
- ISO ClaimSearch
- 4n6xprt Systems StiffCalcs
- ARSoftware WinSMAC