Claims Adjusters, Examiners, and Investigators

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$72,230 Median Wage (2022)
20,600 Projected job openings (2022-2032)
-3.10% Projected growth (2022-2032)

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.

Experience Requirements Overview

  • Job Zone Four: Considerable Preparation Needed
  • A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
  • Most of these occupations require a four-year bachelor's degree, but some do not.
  • Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.

Education, Training and Experience

Required Level of Education: Bachelor's Degree

Related Work Experience: Over 2 years, up to and including 4 years

On-Site or In-Plant Training: Over 6 months, up to and including 1 year

On-the-Job Training: Over 6 months, up to and including 1 year

Detailed Work Activities

  • Calculate data to inform organizational operations.
  • Investigate legal issues.
  • Prepare legal or investigatory documentation.
  • Estimate costs of goods or services.
  • Appraise property values.
  • Interview witnesses, suspects, or claimants.
  • Negotiate agreements to resolve disputes.
  • Implement financial decisions.
  • Advise others on financial matters.
  • Apply information technology to solve business or other applied problems.
  • Resolve customer complaints or problems.
  • Pay charges, fees, or taxes.
  • Verify accuracy of records.
  • Maintain data in information systems or databases.
  • Report information to managers or other personnel.
  • Collect evidence for legal proceedings.
  • Meet with individuals involved in legal processes to provide information and clarify issues.
  • Prepare financial documents.
  • Present business-related information to audiences.
  • Supervise employees.
  • Examine financial records.
  • Confer with others about financial matters.
  • Prepare operational reports.
  • Gather financial records.
  • Verify application data to determine program eligibility.
  • Advise others on legal or regulatory compliance matters.

Work Values

Achievement

Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.

Working Conditions

Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.

Recognition

Occupations that satisfy this work value offer advancement, potential for leadership, and are often considered prestigious. Corresponding needs are Advancement, Authority, Recognition and Social Status.

Relationships

Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.

Support

Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.

Independence

Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.

Tasks

  • Examine claims forms and other records to determine insurance coverage.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Pay and process claims within designated authority level.
  • 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.
  • 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.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Investigate and assess damage to property and create or review property damage estimates.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • 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.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Confer with legal counsel on claims requiring litigation.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Collect evidence to support contested claims in court.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Present cases and participate in their discussion at claim committee meetings.
  • Report overpayments, underpayments, and other irregularities.
  • Attend mediations or trials.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.
  • Obtain credit information from banks and other credit services.
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.

Work Styles

Achievement/Effort

Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.

Persistence

Job requires persistence in the face of obstacles.

Initiative

Job requires a willingness to take on responsibilities and challenges.

Leadership

Job requires a willingness to lead, take charge, and offer opinions and direction.

Cooperation

Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.

Concern for Others

Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.

Social Orientation

Job requires preferring to work with others rather than alone, and being personally connected with others on the job.

Self-Control

Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.

Stress Tolerance

Job requires accepting criticism and dealing calmly and effectively with high-stress situations.

Adaptability/Flexibility

Job requires being open to change (positive or negative) and to considerable variety in the workplace.

Dependability

Job requires being reliable, responsible, and dependable, and fulfilling obligations.

Attention to Detail

Job requires being careful about detail and thorough in completing work tasks.

Integrity

Job requires being honest and ethical.

Independence

Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.

Innovation

Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems.

Analytical Thinking

Job requires analyzing information and using logic to address work-related issues and problems.

Data Source: This page includes information from the O*NET 28.0 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license. O*NET® is a trademark of USDOL/ETA. This page includes Employment Projections program, Occupational Employment and Wage Statistics program, U.S. Bureau of Labor Statistics.