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Claims Adjusters, Examiners, and Investigators
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.
Also Known As:
Claims Adjuster
Claims Analyst
Claims Examiner
Claims Representative
Claims Specialist
Corporate Claims Examiner
Field Claims Adjuster
General Adjuster
Home Office Claims Specialist
Litigation Claims Representative
Wages
Annual wages for Claims Adjusters, Examiners, and Investigators in United States
Job Outlook
Below Average
New job opportunities are less likely in the future
United States
2034 Projected Employment
337,900
-5% Change From 2024
Explore Claims Adjusters, Examiners, and Investigators video
Tasks you might complete in a day.
- Prepare reports to be submitted to company's data processing department.
- Analyze information gathered by investigation and report findings and recommendations.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- 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.
- Examine claims forms and other records to determine insurance coverage.
- Present cases and participate in their discussion at claim committee meetings.
- 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.
- Investigate and assess damage to property and create or review property damage estimates.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Obtain credit information from banks and other credit services.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- 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.
- Confer with legal counsel on claims requiring litigation.
- Pay and process claims within designated authority level.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Collect evidence to support contested claims in court.
- Attend mediations or trials.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Analyze information gathered by investigation and report findings and recommendations.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- 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.
- Report overpayments, underpayments, and other irregularities.
- 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.
Subject areas you may need to master.
- Administrative - Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.
- History and Archeology - Knowledge of historical events and their causes, indicators, and effects on civilizations and cultures.
- Foreign Language - Knowledge of the structure and content of a foreign (non-English) language including the meaning and spelling of words, rules of composition and grammar, and pronunciation.
- Telecommunications - Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems.
- Law and Government - Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
- Administration and Management - Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
- Economics and Accounting - Knowledge of economic and accounting principles and practices, the financial markets, banking, and the analysis and reporting of financial data.
- Design - Knowledge of design techniques, tools, and principles involved in production of precision technical plans, blueprints, drawings, and models.
- Building and Construction - Knowledge of materials, methods, and the tools involved in the construction or repair of houses, buildings, or other structures such as highways and roads.
- Sociology and Anthropology - Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures, and their history and origins.
- Public Safety and Security - Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.
- English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, and rules of composition and grammar.
- Philosophy and Theology - Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.
- Customer and Personal Service - Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
- Physics - Knowledge and prediction of physical principles, laws, their interrelationships, and applications to understanding fluid, material, and atmospheric dynamics, and mechanical, electrical, atomic and sub-atomic structures and processes.
- Geography - Knowledge of principles and methods for describing the features of land, sea, and air masses, including their physical characteristics, locations, interrelationships, and distribution of plant, animal, and human life.
- Medicine and Dentistry - Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Sales and Marketing - Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.
- Engineering and Technology - Knowledge of the practical application of engineering science and technology. This includes applying principles, techniques, procedures, and equipment to the design and production of various goods and services.
- Therapy and Counseling - Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.
- Education and Training - Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.
- Communications and Media - Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media.
- Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
- Transportation - Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including the relative costs and benefits.
- Mechanical - Knowledge of machines and tools, including their designs, uses, repair, and maintenance.
- Biology - Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
- Psychology - Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.
- Chemistry - Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.
- Production and Processing - Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods.
- Food Production - Knowledge of techniques and equipment for planting, growing, and harvesting food products (both plant and animal) for consumption, including storage/handling techniques.
- Fine Arts - Knowledge of the theory and techniques required to compose, produce, and perform works of music, dance, visual arts, drama, and sculpture.
- Personnel and Human Resources - Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems.
Strengths you may need in this role.
- Writing - Writing things for co-workers or customers.
- Monitoring - Keeping track of how well people and/or groups are doing in order to make improvements.
- Coordination - Changing what is done based on other people's actions.
- Equipment Selection - Deciding what kind of tools and equipment are needed to do a job.
- Systems Analysis - Figuring out how a system should work and how changes in the future will affect it.
- Science - Using scientific rules and strategies to solve problems.
- Management of Personnel Resources - Selecting and managing the best workers for a job.
- Complex Problem Solving - Noticing a problem and figuring out the best way to solve it.
- Equipment Maintenance - Planning and doing the basic maintenance on equipment.
- Service Orientation - Looking for ways to help people.
- Operation and Control - Using equipment or systems.
- Quality Control Analysis - Testing how well a product or service works.
- Social Perceptiveness - Understanding people's reactions.
- Operations Analysis - Figuring out what a product or service needs to be able to do.
- Persuasion - Talking people into changing their minds or their behavior.
- Installation - Installing equipment, machines, wiring, or computer programs.
- Judgment and Decision Making - Thinking about the pros and cons of different options and picking the best one.
- Reading Comprehension - Reading work-related information.
- Active Learning - Figuring out how to use new ideas or things.
- Operations Monitoring - Watching gauges, dials, or display screens to make sure a machine is working.
- Negotiation - Bringing people together to solve differences.
- Programming - Writing computer programs.
- Technology Design - Making equipment and technology useful for customers.
- Management of Financial Resources - Making spending decisions and keeping track of what is spent.
- Mathematics - Using math to solve problems.
- Instructing - Teaching people how to do something.
- Systems Evaluation - Measuring how well a system is working and how to improve it.
- Critical Thinking - Thinking about the pros and cons of different ways to solve a problem.
- Repairing - Repairing machines or systems using the right tools.
- Active Listening - Listening to others, not interrupting, and asking good questions.
- Learning Strategies - Using the best training or teaching strategies for learning new things.
- Time Management - Managing your time and the time of other people.
- Speaking - Talking to others.
- Troubleshooting - Figuring out what is causing equipment, machines, wiring, or computer programs to not work.
- Management of Material Resources - Managing equipment and materials.
- Near Vision - Seeing details up close.
- Sound Localization - Noticing the direction that a sound came from.
- Speech Recognition - Recognizing spoken words.
- Problem Sensitivity - Noticing when problems happen.
- Flexibility of Closure - Seeing hidden patterns.
- Rate Control - Changing when and how fast you move based on how something else is moving.
- Written Expression - Communicating by writing.
- Deductive Reasoning - Using rules to solve problems.
- Multilimb Coordination - Using your arms and/or legs together while sitting, standing, or lying down.
- Static Strength - Lifting, pushing, pulling, or carrying.
- Oral Comprehension - Listening and understanding what people say.
- Inductive Reasoning - Making general rules or coming up with answers from lots of detailed information.
- Response Orientation - Quickly deciding if you should move your hand, foot, or other body part.
- Extent Flexibility - Bending, stretching, twisting, or reaching with your body, arms, and/or legs.
- Time Sharing - Doing two or more things at the same time.
- Far Vision - Seeing details that are far away.
- Wrist-Finger Speed - Making fast, simple, repeated movements of your fingers, hands, and wrists.
- Gross Body Equilibrium - Keeping your balance or staying upright.
- Glare Sensitivity - Seeing something even if there is a glare or very bright light.
- Number Facility - Adding, subtracting, multiplying, or dividing.
- Originality - Creating new and original ideas.
- Fluency of Ideas - Coming up with lots of ideas.
- Speed of Closure - Quickly knowing what you are looking at.
- Explosive Strength - Jumping, sprinting, or throwing something.
- Peripheral Vision - Seeing something to your side when your are looking ahead.
- Dynamic Strength - Exercising for a long time without your muscles getting tired.
- Written Comprehension - Reading and understanding what is written.
- Spatial Orientation - Knowing where things are around you.
- Finger Dexterity - Putting together small parts with your fingers.
- Auditory Attention - Paying attention to one sound while there are other distracting sounds.
- Dynamic Flexibility - Quickly and repeatedly bending, stretching, twisting, or reaching out with your body, arms, and/or legs.
- Depth Perception - Deciding which thing is closer or farther away from you, or deciding how far away it is from you.
- Perceptual Speed - Quickly comparing groups of letters, numbers, pictures, or other things.
- Manual Dexterity - Holding or moving items with your hands.
- Reaction Time - Quickly moving your hand, finger, or foot based on a sound, light, picture or other command.
- Hearing Sensitivity - Telling the difference between sounds.
- Gross Body Coordination - Moving your arms, legs, and mid-section together while your whole body is moving.
- Visual Color Discrimination - Noticing the difference between colors, including shades and brightness.
- Speech Clarity - Speaking clearly.
- Mathematical Reasoning - Choosing the right type of math to solve a problem.
- Visualization - Imagining how something will look after it is moved around or changed.
- Selective Attention - Paying attention to something without being distracted.
- Category Flexibility - Grouping things in different ways.
- Trunk Strength - Using your lower back and stomach.
- Information Ordering - Ordering or arranging things.
- Arm-Hand Steadiness - Keeping your arm or hand steady.
- Oral Expression - Communicating by speaking.
- Control Precision - Quickly changing the controls of a machine, car, truck or boat.
- Speed of Limb Movement - Quickly moving your arms and legs.
- Memorization - Remembering words, numbers, pictures, or steps.
- Stamina - Exercising for a long time without getting out of breath.
- Night Vision - Seeing at night or under low light.
Average Education Attained
Highest level of education earned by people in this career.
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Content sourced from United States Department of Labor Employment and Training Administration ("DOLETA") and the Minnesota Department of Employment & Economic Development ("DEED")