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Claims Adjusters, Examiners, and Investigators

It's a bright outlook for

This career will grow rapidly in the next few years.

Learn more about what they do.

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.

Related: Customer Service Representatives Eligibility Interviewers, Government Programs Insurance Claims & Policy Processing Clerks Insurance Underwriters Tax Examiners & Collectors, & Revenue Agents

Industries: Finance & Insurance Government

Summary
Details

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

Equipment Selection
- Deciding what kind of tools and equipment are needed to do a job.
Monitoring
- Keeping track of how well people and/or groups are doing in order to make improvements.
Science
- Using scientific rules and strategies to solve problems.
Coordination
- Changing what is done based on other people's actions.
Writing
- Writing things for co-workers or customers.
Management of Personnel Resources
- Selecting and managing the best workers for a job.
Systems Analysis
- Figuring out how a system should work and how changes in the future will affect it.
Active Learning
- Figuring out how to use new ideas or things.
Negotiation
- Bringing people together to solve differences.
Reading Comprehension
- Reading work-related information.
Persuasion
- Talking people into changing their minds or their behavior.
Technology Design
- Making equipment and technology useful for customers.
Equipment Maintenance
- Planning and doing the basic maintenance on equipment.
Service Orientation
- Looking for ways to help people.
Programming
- Writing computer programs.
Judgment and Decision Making
- Thinking about the pros and cons of different options and picking the best one.
Quality Control Analysis
- Testing how well a product or service works.
Social Perceptiveness
- Understanding people's reactions.
Complex Problem Solving
- Noticing a problem and figuring out the best way to solve it.
Operations Monitoring
- Watching gauges, dials, or display screens to make sure a machine is working.
Installation
- Installing equipment, machines, wiring, or computer programs.
Operations Analysis
- Figuring out what a product or service needs to be able to do.
Operation and Control
- Using equipment or systems.
Active Listening
- Listening to others, not interrupting, and asking good questions.
Troubleshooting
- Figuring out what is causing equipment, machines, wiring, or computer programs to not work.
Management of Financial Resources
- Making spending decisions and keeping track of what is spent.
Speaking
- Talking to others.
Learning Strategies
- Using the best training or teaching strategies for learning new things.
Instructing
- Teaching people how to do something.
Repairing
- Repairing machines or systems using the right tools.
Management of Material Resources
- Managing equipment and materials.
Critical Thinking
- Thinking about the pros and cons of different ways to solve a problem.
Time Management
- Managing your time and the time of other people.
Systems Evaluation
- Measuring how well a system is working and how to improve it.
Mathematics
- Using math to solve problems.

Speech Recognition
- Recognizing spoken words.
Sound Localization
- Noticing the direction that a sound came from.
Inductive Reasoning
- Making general rules or coming up with answers from lots of detailed information.
Oral Comprehension
- Listening and understanding what people say.
Response Orientation
- Quickly deciding if you should move your hand, foot, or other body part.
Written Expression
- Communicating by writing.
Problem Sensitivity
- Noticing when problems happen.
Wrist-Finger Speed
- Making fast, simple, repeated movements of your fingers, hands, and wrists.
Near Vision
- Seeing details up close.
Deductive Reasoning
- Using rules to solve problems.
Flexibility of Closure
- Seeing hidden patterns.
Static Strength
- Lifting, pushing, pulling, or carrying.
Rate Control
- Changing when and how fast you move based on how something else is moving.
Glare Sensitivity
- Seeing something even if there is a glare or very bright light.
Multilimb Coordination
- Using your arms and/or legs together while sitting, standing, or lying down.
Extent Flexibility
- Bending, stretching, twisting, or reaching with your body, arms, and/or legs.
Time Sharing
- Doing two or more things at the same time.
Gross Body Equilibrium
- Keeping your balance or staying upright.
Far Vision
- Seeing details that are far away.
Perceptual Speed
- Quickly comparing groups of letters, numbers, pictures, or other things.
Explosive Strength
- Jumping, sprinting, or throwing something.
Fluency of Ideas
- Coming up with lots of ideas.
Originality
- Creating new and original ideas.
Auditory Attention
- Paying attention to one sound while there are other distracting sounds.
Spatial Orientation
- Knowing where things are around you.
Dynamic Strength
- Exercising for a long time without your muscles getting tired.
Peripheral Vision
- Seeing something to your side when your are looking ahead.
Number Facility
- Adding, subtracting, multiplying, or dividing.
Reaction Time
- Quickly moving your hand, finger, or foot based on a sound, light, picture or other command.
Hearing Sensitivity
- Telling the difference between sounds.
Written Comprehension
- Reading and understanding what is written.
Dynamic Flexibility
- Quickly and repeatedly bending, stretching, twisting, or reaching out with your body, arms, and/or legs.
Depth Perception
- Deciding which thing is closer or farther away from you, or deciding how far away it is from you.
Finger Dexterity
- Putting together small parts with your fingers.
Visual Color Discrimination
- Noticing the difference between colors, including shades and brightness.
Gross Body Coordination
- Moving your arms, legs, and mid-section together while your whole body is moving.
Speed of Closure
- Quickly knowing what you are looking at.
Manual Dexterity
- Holding or moving items with your hands.
Speech Clarity
- Speaking clearly.
Oral Expression
- Communicating by speaking.
Control Precision
- Quickly changing the controls of a machine, car, truck or boat.
Stamina
- Exercising for a long time without getting out of breath.
Night Vision
- Seeing at night or under low light.
Category Flexibility
- Grouping things in different ways.
Visualization
- Imagining how something will look after it is moved around or changed.
Trunk Strength
- Using your lower back and stomach.
Memorization
- Remembering words, numbers, pictures, or steps.
Arm-Hand Steadiness
- Keeping your arm or hand steady.
Mathematical Reasoning
- Choosing the right type of math to solve a problem.
Selective Attention
- Paying attention to something without being distracted.
Information Ordering
- Ordering or arranging things.
Speed of Limb Movement
- Quickly moving your arms and legs.

Design
- Knowledge of design techniques, tools, and principles involved in production of precision technical plans, blueprints, drawings, and models.
Sociology and Anthropology
- Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures, and their history and origins.
Telecommunications
- Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems.
Foreign Language
- Knowledge of the structure and content of a foreign (non-English) language including the meaning and spelling of words, rules of composition and grammar, and pronunciation.
Law and Government
- Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
History and Archeology
- Knowledge of historical events and their causes, indicators, and effects on civilizations and cultures.
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.
English Language
- Knowledge of the structure and content of the English language including the meaning and spelling of words, and rules of composition and grammar.
Philosophy and Theology
- Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.
Administration and Management
- Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
Administrative
- Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.
Economics and Accounting
- Knowledge of economic and accounting principles and practices, the financial markets, banking, and the analysis and reporting of financial data.
Public Safety and Security
- Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.
Sales and Marketing
- Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.
Communications and Media
- Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media.
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.
Mathematics
- Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Physics
- Knowledge and prediction of physical principles, laws, their interrelationships, and applications to understanding fluid, material, and atmospheric dynamics, and mechanical, electrical, atomic and sub-atomic structures and processes.
Medicine and Dentistry
- Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
Therapy and Counseling
- Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
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.
Engineering and Technology
- Knowledge of the practical application of engineering science and technology. This includes applying principles, techniques, procedures, and equipment to the design and production of various goods and services.
Geography
- Knowledge of principles and methods for describing the features of land, sea, and air masses, including their physical characteristics, locations, interrelationships, and distribution of plant, animal, and human life.
Biology
- Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
Psychology
- Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
Personnel and Human Resources
- Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems.
Food Production
- Knowledge of techniques and equipment for planting, growing, and harvesting food products (both plant and animal) for consumption, including storage/handling techniques.
Computers and Electronics
- Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
Chemistry
- Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
Mechanical
- Knowledge of machines and tools, including their designs, uses, repair, and maintenance.
Fine Arts
- Knowledge of the theory and techniques required to compose, produce, and perform works of music, dance, visual arts, drama, and sculpture.
Transportation
- Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including the relative costs and benefits.
Production and Processing
- Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods.

Education

High school diploma or equivalent

Work Experience

No work experience

Training

More than 1 year on-the-job training

Education and Training Opportunities

Washington Annual Salary

80100/yr

Washington Hourly Wage

38.51/hr

Currently Employed

6,030

Yearly Projected Openings

410

Conventional: People interested in this work like activities that include data, detail, and regular routines. They do well at jobs that need:

Cautiousness
Integrity
Attention to Detail
Dependability
Perseverance
Self-Control

Automotive computer systems
Desktop computers
Measuring wheels for distance
Notebook computers
Personal computers
Personal digital assistant PDAs or organizers
Portable data input terminals
Scanners
Tablet computers
Theodolites

Access software
Analytical or scientific software
Computer aided design CAD software
Data base reporting software
Data base user interface and query software
Desktop publishing software
Document management software
Electronic mail software
Enterprise resource planning ERP software
Expert system software
Financial analysis software
Information retrieval or search software
Interactive voice response software
Internet browser software
Medical software
Office suite software
Presentation software
Spreadsheet software
Video conferencing software
Word processing software

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Claims Adjusters, Examiners, and Investigators

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