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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

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

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

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

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.
Sociology and Anthropology
- Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures, and their history and origins.
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.
Law and Government
- Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
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.
Design
- Knowledge of design techniques, tools, and principles involved in production of precision technical plans, blueprints, drawings, and models.
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.
Telecommunications
- Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems.
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.
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.
History and Archeology
- Knowledge of historical events and their causes, indicators, and effects on civilizations and cultures.
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.
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.
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.
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.
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.
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.
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.
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.
Production and Processing
- Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods.
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.
Mechanical
- Knowledge of machines and tools, including their designs, uses, repair, and maintenance.
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.
Fine Arts
- Knowledge of the theory and techniques required to compose, produce, and perform works of music, dance, visual arts, drama, and sculpture.
Biology
- Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
Transportation
- Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including the relative costs and benefits.
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.

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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