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Also known as:
Claims Analyst, Fire Claims Adjuster, Health Claims Examiner, Health Insurance Adjuster, Independent Insurance Adjuster, Medical Claims Analyst, Medical Claims Examiner, Property and Casualty Insurance Claims Examiner, Property Damage Claims Adjustor, Reinsurance Claims Analyst
When insured property is damages of stolen, it is necessary to file a "claim" notifying the insurance company and seeking payment for the loss. Simple claims are handled over the phone. But large or complex claims are typically assigned to insurance adjusters and examiners, also known as "claim adju ...
It is their job to interview the policyholder, assess the damage, and determine how much the insurance company will pay. They may also examine the claim in detail, talking to police officers, witnesses, and medical personnel to make sure that the claim is legitimate.
Some claims adjusters work with multiple kinds of insurance. Others specialize in fire damage, marine loss, automotive damage, worker's compensation, or other areas. Many find the dual responsibility of protecting the company from insurance fraud while authorizing payments to people who have suffered a loss to be both challenging and rewarding.
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.
Critical decision making
Level of responsibilities
Job challenge and pressure to meet deadlines
Dealing and handling conflict
Competition for this position
Communication with others
Work closely with team members, clients etc.
Comfort of the work setting
Exposure to extreme environmental conditions
Exposure to job hazards
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Collect evidence to support contested claims in court.
Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
Refer questionable claims to investigator or claims adjuster for investigation or settlement.
Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
Prepare report of findings of investigation.
Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
Examine claims forms and other records to determine insurance coverage.
Analyze information gathered by investigation, and report findings and recommendations.
Identifying Objects, Actions, and Events
Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
Interacting With Computers
Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
Observing, receiving, and otherwise obtaining information from all relevant sources.
Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
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.
Making Decisions and Solving Problems
Analyzing information and evaluating results to choose the best solution and solve problems.
Resolving Conflicts and Negotiating with Others
Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
AREAS OF KNOWLEDGE
Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Customer and Personal Service
Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
Law and Government
Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Building and Construction
Knowledge of materials, methods, and the tools involved in the construction or repair of houses, buildings, or other structures such as highways and roads.
Education and Training
Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
Computers and Electronics
Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
The ability to listen to and understand information and ideas presented through spoken words and sentences.
The ability to read and understand information and ideas presented in writing.
The ability to communicate information and ideas in speaking so others will understand.
The ability to apply general rules to specific problems to produce answers that make sense.
The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
The ability to speak clearly so others can understand you.
The ability to communicate information and ideas in writing so others will understand.
The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
Understanding written sentences and paragraphs in work related documents.
Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Talking to others to convey information effectively.
Bringing others together and trying to reconcile differences.
Communicating effectively in writing as appropriate for the needs of the audience.
Understanding the implications of new information for both current and future problem-solving and decision-making.
Judgment and Decision Making
Considering the relative costs and benefits of potential actions to choose the most appropriate one.