Claims Adjusters, Examiners, and Investigators

What the job really is

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.

At a glance

• Sector: Business & Financial
• O*NET-SOC code: 13-1031
• O*NET job zone: 4 — considerable preparation
• Work sample tasks on file: 12
• Tools and technologies listed: 12

What you actually do

Work sample tasks recorded for this occupation:

• 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.

Tools and technology

Apple Safari, Microsoft Access, Microsoft Excel, Microsoft Office software, Microsoft Outlook, Microsoft PowerPoint, Microsoft Word, Mozilla Firefox, Xactware Xactimate, Zoom, 4n6xprt Systems StiffCalcs, ADP software

What employers expect you to already be comfortable with.

Where this job leads

Related occupations — the usual moves up and sideways:

• Insurance Claims and Policy Processing Clerks
• Eligibility Interviewers, Government Programs
• Customer Service Representatives
• Insurance Underwriters
• Tax Examiners and Collectors, and Revenue Agents
• Compliance Officers
• Compensation, Benefits, and Job Analysis Specialists
• Insurance Sales Agents

Getting in

O*NET assigns this occupation job zone 4 (considerable preparation). The related occupations above are the realistic routes in and out.

Find openings

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Check this against the source

O*NET OnLine: Claims Adjusters, Examiners, and Investigators — the authoritative public-domain profile this page is derived from, including the full task list, reported skills and the wage estimates for your region.

Derived and rewritten from the public-domain O*NET database (U.S. Department of Labor / Employment and Training Administration). Figures are observations, not promises — always confirm salary, licensing and visa requirements with the employer and the relevant authority.