Insurance Claims Adjuster and Examiner
An Insurance Claims Adjuster and Examiner is a professional responsible for investigating and settling claims made by policyholders to insurance companies. These individuals assess damages from events such as accidents or natural disasters, often visiting sites to evaluate the extent of the damage and gather necessary information. Claims adjusters write detailed reports to recommend whether claims should be approved, while examiners may review these reports for accuracy and compliance with company procedures. The role typically requires strong organizational and investigative skills, along with the ability to provide customer support to clients who may be experiencing significant losses.
Adjusters and examiners work both in offices and in the field, often requiring them to travel to various locations such as homes, accident scenes, and auto repair shops. They usually work a standard forty-hour week but may be on-call, especially during peak times or emergencies. Although a high school diploma is the minimum requirement, further education in fields like finance or economics can be beneficial. The median yearly earnings for this profession are approximately $75,020. However, job growth in this sector is projected to decline by about 3 percent, indicating a competitive job market.
Insurance Claims Adjuster and Examiner
Snapshot
Career Cluster(s): Business, Management & Administration, Finance
Interests: Investigation, risk assessment, solving problems, helping others
Earnings (Yearly Median): $75,020 per year, $36.07 per hour (2023)
Employment & Outlook: -3 percent (Decline)
Entry-Level Education High school diploma or equivalent
Related Work Experience None
On-the-job-Training Short-term on-the-job training
Overview
Sphere of Work. Insurance claims adjusters and examiners, also referred to as insurance claims investigators, insurance claims assessors, insurance claims analysts, and liability assessors, are responsible for investigating and settling claims that insurance policyholders have made to their insurance companies. Adjusters visit the scene of an accident, injury, or natural disaster and estimate the cost of the damage done. They write reports recommending whether the claim should be approved or not. Examiners are very similar to adjusters, although in some companies, they may follow up on adjusters’ work by checking their reports for accuracy and to ensure that the adjuster has followed the insurance company’s procedures properly. Adjusters and examiners may be independent agents or employed by insurance companies.
Work Environment. Insurance claims adjusters and examiners work in offices writing and evaluating claims reports as well as in the field investigating claims and inspecting damaged property. They visit claimants and insurance policyholders at their homes, accident scenes, hospitals and rehabilitation facilities, and automobile repair shops. Insurance claims adjusters and examiners may work a forty-hour week or in an on-call capacity, responding to claims as they are made. They may be expected to work overtime during busy times or when responding to emergencies or natural disasters that affect many people at once. When investigating claims in the field, especially in the aftermath of an event like a tornado or a fire, insurance claims adjusters and examiners may be exposed to physical hazards.
Occupation Interest. Individuals attracted to the insurance claims adjuster and examiner profession tend to be organized, diplomatic, and detail-oriented people who find satisfaction in resolving questions and helping people in times of need. Those individuals who excel as insurance claims adjusters and examiners exhibit traits, such as responsibility, time management, composure under pressure, attention to detail, and a desire to help. Insurance claims adjusters and examiners should enjoy insurance work and have a background in investigation and risk assessment.
A Day in the Life—Duties and Responsibilities. The daily duties and responsibilities of insurance claims adjusters and examiners will vary with job specialty and employer. Areas of insurance claims specialization include claims adjusters, appraisers, examiners, and investigators. Insurance claims adjusters and examiners investigate and settle property damage, liability, and bodily injury claims. Insurance companies encourage insurance claims adjusters and examiners to settle claims without legal arbitration whenever possible.
When they receive claims, insurance claims adjusters and examiners may begin work by reviewing insurance policies to determine what type and amount of coverage applies to the claim. They may travel to the site of the damaged property and confirm the cause and extent of the damage; they may interview people involved in the incident, including policyholders, witnesses, first responders (police, firemen, and paramedics), and physicians. They gather information and records related to the incident, such as police reports, and work with appraisers, colleagues, and relevant professionals, such as builders or auto mechanics, to determine the extent of the damage. Providing emotional and customer service support to customers is a very important aspect of processing claims, especially since customers may have experienced a personal loss or a significant loss of property due to the event. Claims adjusters and examiners may assist policyholders with various requests and communicate with them about the process of investigating the claim. If a widespread natural disaster occurs, the adjuster may be sent to assist local residents with the filing of their claims before the evaluation process begins.
When the initial work is complete, insurance claims adjusters and examiners prepare the claim report and attempt to negotiate a monetary settlement with the policyholder. Most of the time, this is successful, but if the claimant contests the company’s decision regarding a claim, sometimes claims adjusters and examiners must initiate legal proceedings if an out-of-court settlement cannot be reached. The final claims report is submitted by the adjuster or examiner to supervisors at the insurance company. Examiners are also responsible for checking the accuracy of adjusters’ reported findings and for confirming that adjusters followed correct procedures while investigating the claim or claims.
All insurance claims adjusters and examiners should stay up to date with regulatory and ethical issues and news in the insurance industry by reading insurance industry journals and participating in insurance industry associations.
On average, claims adjusters, examiners, and investigators earn slightly more ($75,050 annually) than those who appraise vehicle damage $74,520).
Work Environment
Immediate Physical Environment. Insurance claims adjusters and examiners work in office environments as well as in the field, investigating claims and visiting damaged property and injured people. Insurance claims adjusters and examiners generally must be physically able to drive as well as walk over potentially rough terrain damaged by flood, winds, earthquakes, and fire.
Human Environment. Insurance claims adjusters and examiners interact with insurance policyholders, lawyers, doctors, automobile repair mechanics, business owners, and coworkers and supervisors. Insurance claims adjusters and examiners should be comfortable meeting with policyholders and industry professionals and show good judgment, objectivity, and tact when responding to policyholders.
Technological Environment. Insurance claims adjusters and examiners use computers, smartphones, tablets, tape measures, cameras, calculators, Internet communication tools, insurance business software programs, and spreadsheets to complete their work.
Education, Training, and Advancement
High School/Secondary. High school students interested in pursuing a career as an insurance claims adjuster or examiner should prepare by building good study habits. High school-level study of sociology, bookkeeping, and mathematics will provide a strong foundation for work as an insurance claims adjuster and examiner or for college-level study in the field. High school students interested in this career path will benefit from seeking internships or part-time work with insurance businesses or investigators.
Postsecondary. Postsecondary students interested in becoming insurance claims adjusters and examiners should work toward an associate’s or bachelor’s degree in economics, finance, statistics, or accounting. Coursework in computer science, political science, and ethics may also prove useful in their future work. Postsecondary students can gain work experience and potential advantage in their future job searches by securing internships or part-time employment with local insurance businesses.
Related Occupations
− Appraiser and Assessor of Real Estate
Bibliography
"Claims Adjusters, Appraisers, Examiners, and Investigators." US Bureau of Labor Statistics, 17 Apr. 2024, www.bls.gov/ooh/business-and-financial/claims-adjusters-appraisers-examiners-and-investigators.htm. Accessed 23 Aug. 2024.
"Claims Adjusters, Examiners, and Investigators." O*NET OnLine, 6 Aug. 2024, www.onetonline.org/link/summary/13-1031.00. Accessed 23 Aug. 2024.
"Insurance Appraisers, Auto Damage." O*NET OnLine, 6 Aug. 2024, www.onetonline.org/link/summary/13-1032.00. Accessed 23 Aug. 2024.