Claims AdjusterJob Description, Salary, Career Path, and Trends
A claims adjuster is responsible for investigating, assessing, and resolving insurance claims. They work with customers, insurance companies, and agents to ensure that all claims are handled fairly and in accordance with company policy.
The majority of claims adjusters work for insurance companies, although some may work for third-party claim processing companies. They typically have a college degree in business, economics, accounting, or a related field.
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.
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
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
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.
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
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
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
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
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
Average salary and compensation
The average salary for a claims adjuster is $50,850. They may receive additional pay for overtime or travel. They may also receive a benefits package, which includes health insurance, dental insurance, and a 401(k) plan.
Los Angeles, California
Minneapolis-St. Paul, Minnesota
New York City, New York
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?
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