What Does a Claims Adjuster Do?
Claims adjusters evaluate and settle insurance claims on behalf of insurance companies. Their responsibilities include investigating the claim, gathering evidence, determining the extent of the insurance company’s liability, negotiating settlements, and communicating with all parties involved in the claims process. Claim Adjusters are responsible for resolving claims fairly and efficiently while balancing the interests of insurance companies and policyholders.
The majority of claims adjusters work directly 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.
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National Average Salary
Claims adjuster salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a Claims Adjuster is:
Claims Adjuster Job Descriptions
When it comes to recruiting a claims adjuster, having the right job description can make a big difference. Here are some real world job descriptions you can use as templates for your next opening.
We seeking a highly motivated claims adjuster to join our team. Claims adjusters establish the business parameters of each claim by analyzing customer applications, company guidelines, laws/regulations, and cost-effectiveness. They also interpret computerized data systems to determine the scope of coverage available for losses that may occur within a policy or aggregate policy, identify covered properties, and assess risk. The responsibilities of claims adjusters include evaluating, investigating, and resolving claims according to company policy and state laws, establishing business parameters of every claim, communicating with customers throughout the claims process, and monitoring claims for possible fraud and misrepresentation. As a claims adjuster, you’ll be responsible for helping customers get back on the road after an accident. You’ll have the support of a collaborative team and ongoing coaching from leaders.
Typical duties and responsibilities
- Investigate insurance claims and determine if the insurance company should pay the claim
- Review medical records, police reports, and other documents related to the claim
- Determine the value of a claim and whether the insurance company should pay for damages, medical expenses, or other losses
- Prepare reports on their findings and make recommendations to the insurance company
- Negotiate with claimants to reach a settlement
- Represent the insurance company in court proceedings if a claim goes to trial
Education and experience
- A college degree is not required for this job, but some insurance companies may prefer to hire claims adjusters with a degree in business, economics, mathematics, or a related field
- Claims adjusters typically have at least three years of experience investigating insurance claims
- The ability to investigate each claim thoroughly and accurately
- They must be able to communicate effectively with claimants, witnesses, lawyers, insurance company representatives, doctors, and other professionals
Required skills and qualifications
- Thorough knowledge of insurance claims process
- Investigative skills
- Strong communication and negotiation skills
- Problem-solving skills
- Ability to work independently
- Ability to travel around the state
- Bilingual abilities
- Familiarity with computers and software applications used in investigations, including databases and specific claims software programs
- Strong negotiation skills are important for this job
- They should have good problem-solving skills since claims can become very complicated
- Experience in the insurance industry is helpful, but not always necessary, as many claims adjusters come from a customer service background
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 the 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 the 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 the 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 education and experience
- 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
- 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
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, is able to perform basic math calculations while managing time well to meet time-sensitive deadlines, is well organized, and displays critical thinking skills.
- 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 as conducting recorded statements
- Ensure timely assignment of appraisals using company-approved vendors, provide rental vehicles to claimants as needed, and 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’s degree in Business or another related field or equivalent work experience preferred
- INS or other insurance related courses 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
- 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
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.
- 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 the judgment of the extent of disability. Applies knowledge of medical procedures, disabilities, and likely duration to determine an accurate estimate of claim cost
- Completes detailed settlement analysis and recommends appropriate settlement value, utilizing knowledge of appropriate Worker’s Compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, and 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 the 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 the 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, one must meet requirements and obtain certification within the 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
Candidate Certification to Look For
AdjusterPro Claims Adjuster License
This online pre-licensing course includes an online state exam and satisfies all state requirements. No additional coursework or testing is needed. Offered 100% online, our program allows candidates to complete their training anywhere, anytime.
How to Hire a Claims Adjuster
When hiring a claims adjuster, there are several factors to consider:
- Recruiting: Can you source and recruit for this role successfully using your internal resources and tools?
- Complexity: Does a senior professional need to be hired, or could a middle or even junior-level coordinator suffice?
- Duration: Do you have an indefinite need for this project or is it a one-time project?
- Management: Are you capable of directing the work effectively?
- Urgency: Will this role address a pressing need or an ongoing one?
- Headcount: Does this role need to be approved through HR?
Answering these questions will help you determine the most effective approach to bringing on new talent. Situations and needs change frequently, so the answer today may be different than the answer tomorrow. Each scenario can be solved with a wide variety of great options, no matter how unique. For hiring a claims adjuster, we recommend the following options:
1. Use 4 Corner Resources (or another professional recruiting firm)
The heavy lifting is done for you when working with a top-tier staffing company like 4 Corner Resources. We source, screen, recruit, and deliver only the most qualified candidate(s), saving you significant time and effort throughout the hiring process while you remain focused on your core business. Understanding your needs and ensuring the right candidate for the position is the key to our success.
This is the best route to take when:
- You need to fill the position quickly
- You want access to a vast talent pool of high-quality, prescreened candidates
- Your position is suited for temporary hiring services, contract staffing, or contract-to-hire recruiting, and you intend to direct the work activity.
- You are hiring an employee as a direct placement but aren’t able to recruit effectively or efficiently with your internal staff.
- You aren’t familiar with current salary rates, market trends, and available skill sets
2. Advertise your opening on a top job board
Your best option may be to advertise your opening on a proven job board. There are many widely used job sites out there that draw visits from qualified candidates. If you have someone internally who can dedicate the time and energy to sort through applications and screen individuals effectively, this can be a great choice.
We recommend using a job board when:
- Your internal recruiting team has the knowledge and experience to assess candidate qualifications
- You are hiring a direct employee and have time to manage the entire recruiting effort
- You have a process for receiving, screening, and tracking all resumes and applications
- You are prepared to respond to all applicants
We recommend using CareerBuilder when hiring a claims adjuster:
CareerBuilder has been a trusted source for hiring since 1995. Reach 80+ million unique, diverse U.S. job seekers annually by posting your jobs through their talent acquisition channels. Through CareerBuilder, you can engage candidates and drive them into your sourcing pipeline. We recommend using CareerBuilder for hiring when you have the internal resources and processes to review, screen, and reply to all applicants.
3. Leverage your internal resources
You can utilize your own website, social media, and employees to assist in your search for top candidates.
A company website posting should be the first step in notifying prospective candidates that you are hiring. Social media can also be a powerful tool for spreading the word about your new opening. As far as exposure is concerned, this option can be as good as some job boards when you have a large enough following across various platforms, like LinkedIn, Instagram, Facebook, TikTok, and Twitter.
Current employees are every organization’s greatest asset. Encourage your internal team to promote job openings to their network by offering cash and other incentives.
We recommend these options when:
- Your brand has great name recognition
- You can consistently monitor and respond to candidate activity through your website and social media accounts
- You have a process in place to quickly and broadly communicate job openings and requirements
- You have an effective employee referral program in place
If you aren’t sure which path is best, schedule a discovery call today with our seasoned recruiting professionals. The 4 Corner team is on standby to help you find the best option for your unique hiring need.
Sample Interview Questions
- What types of customers have you worked with in the past?
- How do you prioritize your workload and manage multiple claims at the same time?
- How do you stay up-to-date with industry regulations and changes in laws affecting claims?
- How do you communicate with medical providers and gather medical records to support a claim?
- Can you explain your experience with negotiating settlements and resolving disputes?
- 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?