Claims AdjusterJob Description, Salary, Career Path, and Trends

Sample job description #1

The Claims Adjuster handles low to mid-range complexity claims that will consist of a direct investigation of the facts of loss, evaluation of coverages, damages, liability, and negotiation of claims to a proper conclusion. May be involved with litigated files for experience and developmental purposes.

Key responsibilities

• Determines policy status and coverage; reviews appropriate policies and endorsements for coverage, limits, and deductibles; immediately notify manager of any claim that may be outside of assigned scope of handling, level, or authority
• Makes prompt contact with policyholders, claimants, witnesses, and other parties involved in the loss to set expectations, develop an action plan, and perform an initial exposure assessment
• Conducts an investigation to determine coverage, liability, and damages, including recorded statements and coordination of field inspections or experts when necessary based on Department Best Practices
• Ensures regular and timely follow-up and brings claims to prompt and appropriate conclusion while keeping the customer informed throughout the life cycle of the claim process
• Ability to scope and estimate real property, personal property, and time element damages using company approved software applications
• Identifies any subrogation potential and liability exposures and consults with supervisor
• Performs all claims related functions with guided assistance and input from their supervisor
• Maintains electronic records that accurately and thoroughly document all file handling activity
• May be called upon to perform additional duties as directed
• Reasonable and predictable attendance is required

Minimum experience/education

• 2 years or more of claim experience
• High school diploma or equivalent required. Post-secondary education preferred
• Current adjuster licensure or the ability to obtain within 90 days of hire
• Basic computer skills and Microsoft and Google applications preferred

Communication and collaboration skills

• Professional oral and written communication skills are critical to the success of this position. All claims service must be handled with tact, diplomacy and courtesy at all times
• Must be able to collaborate and develop strong team relationships with associates from within and outside the Claims Department
• Customer centric with exceptional customer service skills

Technical knowledge

Must have comprehensive knowledge and understanding of insurance policies and endorsements, as well as the ability to understand complex documents, contracts, and other legal documents.

Problem solving

Gather facts and draw conclusions, interpret complex requirements/issues and work independently. The individual must be able to identify and implement key opportunities while researching potential solutions.

Sample job description #2

Job overview

ABC Company is looking for an Auto Claim Adjuster who will be responsible for evaluating and investigating policy coverage, liability, and damages while providing a high level of customer service when assisting customers and claimants in a timely manner with inquiries regarding the associated claim. The ideal candidate has about 1 to 2 years of prior auto claim adjusting experience, is able to communicate effectively, has excellent negotiation and investigative skills, and is able to perform basic math calculations while managing time well to meet time-sensitive deadlines, is well organized, and displays critical thinking skills.

Responsibilities and duties

• Evaluate and investigate policy coverage, liability, and damages in a timely manner following a set of general claim and statutory guidelines
• Assist customers and claimants with problems or questions regarding claims by phone or through written correspondence, while providing a high level of customer service
• Establish initial reserves for all potential exposures and adjust as appropriate throughout the claim
• Establish and maintain appropriate management of assigned inventory following company guidelines
• Conduct thorough investigations including but not limed to, obtaining necessary documents, forms, and witness statements, as well conducting recorded statements
• Ensure timely assignment of appraisals using company approved vendors, provide rental vehicles to claimants as needed, and be able to determine accident-related damages
• Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority
• Recognize recovery opportunities regarding total loss and salvage, as well as subrogation
• Other duties as assigned

Qualifications

• High School Diploma, GED or equivalent, required
• Bachelor degree in Business or another related field or equivalent work experience, preferred
• INS or other insurance related course, preferred
• Proficient PC and Windows skills
• Proven ability to provide excellent customer service
• Ability to perform basic math calculations – addition, subtraction, multiplication, & division – as well as calculation of averages and percentages

Experience

• 1 – 2 years of auto claim adjusting experience or similar work experience
• Nonstandard Auto experience, a plus

Knowledge, skills, & abilities

• Effective written and verbal communication skills as well as negotiation and investigative skills
• Excellent time management, organizational, and critical thinking skills
• Superb attention to detail to ensure accuracy while meeting time-sensitive deadlines
• Strong ability to prepare and present accurate, reliable, and factual reports with recommendations to appropriate parties
• Ability to be flexible in a fast-paced environment as well as understand and follow oral and/or written policies, procedures, and instructions
• Discretion when handling confidential information
• Exhibit a comfort level working with key people at all levels within an organization

Sample job description #3

The Claims Adjuster performs duties to manage a caseload of low to moderately complex worker’s compensation claims. This consists of determining compensability, setting reserves, and approving payments, in accordance with industry/company Claims Best Practices. Analyzes and interprets statutes and regulations applicable to case facts in order to render appropriate legal and ethical decisions. Analyzes legal issues and directs legal strategy. Manages claims in a prompt and thorough manner from inception through closure. Aggressively negotiates the settlement of claims.

Essential duties and responsibilities:

• With general management oversight, works within assigned authority limits on claims reflecting a low to moderate degree of technical complexity and severity
• Analyzes case facts, applies appropriate statutes and regulations, and identifies possible fraud and abuse, in determining compensability
• Analyzes case facts to establish timely and accurate case reserves. Requires knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Applies knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing knowledge of appropriate Workers Compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices, Social Security, and Medicare application procedure as applicable
• Ensures quality medical management by applying appropriate medical concepts, and by interpreting and applying appropriate statutes and regulations. Requires independent judgment to render accurate decisions
• Proactively manages claim litigation process. Manages legal issues that can be adjudicated without the use of a defense attorney. Directs legal strategy and participates in preparation of the case for litigation. Provides testimony at hearings as needed
• Analyze physician reports for content and accuracy to ensure prompt and appropriate processing of medical and indemnity benefits
• Evaluates, prepares, and manages cases of possible permanent partial disability
• Manages dedicated accounts as assigned. Participates in telephonic claim reviews
• Other duties may be assigned

Job requirements:

• Excellent written and oral communication, listening, interpersonal, customer service and telephone skills
• Proficient in the use and knowledge of MS Office software, with the ability to type at a minimum of 35 wpm
• Demonstrated knowledge of Workers’ Compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. Comprehensive knowledge of AMA Guides to the Evaluation of Permanent Impairment and medical terminology
• Self-motivated with excellent analytical, problem solving and decision-making skills and ability to deal professionally with people in stressful situations. Ability to maintain confidentiality. Conduct business at all times with the highest standards of personal, professional and ethical conduct
• If State Certification is required, must meet requirements and obtain certification within state mandated time frame
• Must have High School Diploma or GED equivalent
• Must possess 2-5 years of related claims experience
• Ability to participate in job related internal and external training and pass any tests within the set guidelines
• Bachelor’s degree or equivalent business experience preferred
• WCCP certification preferred
• Current Experienced Claims Adjuster Designation preferred
• Working knowledge of an imaged claims environment preferred
• Bilingual in English and Spanish preferred
• An equivalent combination of education and experience may be substituted for the requirements listed above

Sample interview questions

• What types of customers have you worked with in the past?
• How comfortable are you with approaching customers on the phone?
• Have you had to use your negotiation skills while working for a previous employer? How did it go?
• How do you feel about working overtime or traveling overnight when necessary?
• Do you think that your previous experience qualifies you to work as a claims adjuster? If not, what would you need to do to be qualified?
• What education and/or experience do you have in the insurance industry?
• What was the most difficult claim that you ever had to investigate and why?
• What is your understanding of the insurance claims process?
• If you were hired as a claims adjuster, what do you think would be your biggest challenge?
• Have you ever had to file a claim with an insurance company? If so, how was the process for you?
• What is your understanding of the insurance adjuster’s role in the industry?