Claims Adjusters, Examiners, and Investigator Career

Job Description: 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.


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Claims Adjusters, Examiners, and Investigator Career

What Claims Adjusters, Examiners, and Investigators do:

  • Examine claims forms and other records to determine insurance coverage.
  • 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.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Confer with legal counsel on claims requiring litigation.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Pay and process claims within designated authority level.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Present cases and participate in their discussion at claim committee meetings.
  • Investigate and assess damage to property and create or review property damage estimates.
  • 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.
  • Collect evidence to support contested claims in court.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • 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.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Report overpayments, underpayments, and other irregularities.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Obtain credit information from banks and other credit services.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.

What work activities are most important?

Importance Activities

Interacting With Computers - Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.

Getting Information - Observing, receiving, and otherwise obtaining information from all relevant sources.

Making Decisions and Solving Problems - Analyzing information and evaluating results to choose the best solution and solve problems.

Communicating with Supervisors, Peers, or Subordinates - Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.

Resolving Conflicts and Negotiating with Others - Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.

Identifying Objects, Actions, and Events - Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.

Processing Information - Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.

Documenting/Recording Information - Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.

Evaluating Information to Determine Compliance with Standards - Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

Communicating with Persons Outside Organization - Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.

Organizing, Planning, and Prioritizing Work - Developing specific goals and plans to prioritize, organize, and accomplish your work.

Analyzing Data or Information - Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.

Updating and Using Relevant Knowledge - Keeping up-to-date technically and applying new knowledge to your job.

Establishing and Maintaining Interpersonal Relationships - Developing constructive and cooperative working relationships with others, and maintaining them over time.

Monitor Processes, Materials, or Surroundings - Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.

Interpreting the Meaning of Information for Others - Translating or explaining what information means and how it can be used.

Performing for or Working Directly with the Public - Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.

Judging the Qualities of Things, Services, or People - Assessing the value, importance, or quality of things or people.

Thinking Creatively - Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.

Performing Administrative Activities - Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.

Estimating the Quantifiable Characteristics of Products, Events, or Information - Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.

Developing Objectives and Strategies - Establishing long-range objectives and specifying the strategies and actions to achieve them.

Inspecting Equipment, Structures, or Material - Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.

Scheduling Work and Activities - Scheduling events, programs, and activities, as well as the work of others.

Monitoring and Controlling Resources - Monitoring and controlling resources and overseeing the spending of money.

Assisting and Caring for Others - Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.

Developing and Building Teams - Encouraging and building mutual trust, respect, and cooperation among team members.

Training and Teaching Others - Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.

Coordinating the Work and Activities of Others - Getting members of a group to work together to accomplish tasks.

Holland Code Chart for a Claims Adjusters, Examiners, and Investigator