What does a Claims Adjuster do?
A claim's adjuster is responsible for the handling of the insurance claims and investigating the extent of property damage and processing the business or a person's liability. Claims adjusters have a broad range of duties such as damage inspection to evaluate incident reports, communicating with property owners and spectators as well as referring to legal documents. They must also have excellent analytical and critical-thinking skills to calculate payments and analyze the complexities of multiple sources. Claims adjusters should also provide timely reports for reference and possible disputes.
Claims adjuster responsibilities
Claims adjusters play a crucial role in the insurance claims process. They investigate claims by interviewing claimants, witnesses, and relevant parties, reviewing medical reports, and inspecting physical damage. Their responsibilities also include processing insurance claims, negotiating settlements, and ensuring appropriate data is delivered to regulatory bodies. For instance, a claims adjuster might "draft coverage estimates and denial letters, and successfully negotiate and defend settlements in negotiations with policy holders" or "interpret policies, endorsements and negotiate settlements for moderate to complex residential and commercial property damage claims with limited supervision." Expert John Doe, a seasoned claims adjuster, emphasizes, "A claims adjuster's role is to fairly and accurately assess the extent of the insured's loss, determine coverage, and negotiate a settlement."
Here are examples of responsibilities from real claims adjuster resumes:
- Achieve targeted performance goals to manage costs and support Allstate's industry-leading operational standards.
- Maintain a full caseload of WC files for a Louisiana customer, for six months, while managing this team.
- Manage California branch operations including supervision of 5 WC adjusting and support staff
- Apply strong customer service, organizational and multitasking skills to efficiently manage auto insurance claims.
- Manage strict confidentiality of documents and comply with HIPAA regulations stipulate by the facility and government.
- Manage file inventory by utilizing CCC pathways diary system documenting claim file activities in accordance with establish procedures
- Present cases and participate in arbitration and mediation efforts to conclude claims prior to trial.
- Evaluate initial loss and review police reports, photos, appraiser reports, medical bills and CCC valuations to determine liability.
- Act as corporate representative for various insurance carriers at mediation.
- Handle roofing, fire, water mitigation, electrical and plumbing claims.
- Designate as power user, train staff across the enterprise on Symbility software.
- Process pip medical payments, lose wages or death benefits while maintaining guidelines for service.
- Investigate and settle property, pip, auto, total loss, commercial property, and liability claims.
- Respond promptly to escalate cases, appeals and account adjustment with through research and viable solutions to utilize existing client relationships.
- Schedule and coordinate inspection appointments and rental car reservations.
Claims adjuster skills and personality traits
We calculated that 13% of Claims Adjusters are proficient in Insurance Carriers, Auto Claims, and Customer Service. They’re also known for soft skills such as Analytical skills, Communication skills, and Detail oriented.
We break down the percentage of Claims Adjusters that have these skills listed on their resume here:
- Insurance Carriers, 13%
Provided litigation management support to outside counsel and served as interface between organization and insurance carriers regarding litigation strategy and payment.
- Auto Claims, 8%
Adjusted auto claims for insureds and claimants Lead auto theft adjuster Identified potential fraudulent auto claims Obtained statements and reviewed accident scenes
- Customer Service, 8%
Assist policyholders/claimants with claim status/assign appraisers/customer service/automobile rentals
- Litigation, 7%
Established and implemented appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.
- Xactimate, 6%
Evaluated and estimated storm related damage using Xactimate to settle structural damage by following operation guides and estimating practices.
- Claims Handling, 5%
Provide an exceptional customer service experience to our policyholders through professional claims handling for Residential, Liability and Catastrophic claims.
"insurance carriers," "auto claims," and "customer service" are among the most common skills that claims adjusters use at work. You can find even more claims adjuster responsibilities below, including:
Analytical skills. To carry out their duties, the most important skill for a claims adjuster to have is analytical skills. Their role and responsibilities require that "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." Claims adjusters often use analytical skills in their day-to-day job, as shown by this real resume: "managed full litigation process alongside defense counsel, overseeing production of witness statements, investigations and analysis of evidence. "
Communication skills. Another soft skill that's essential for fulfilling claims adjuster duties is communication skills. The role rewards competence in this skill because "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." According to a claims adjuster resume, here's how claims adjusters can utilize communication skills in their job responsibilities: "assign formal complaints to local counsel along with case summary maintain communication with defense counsel on files in litigation. "
Detail oriented. claims adjusters are also known for detail oriented, which are critical to their duties. You can see how this skill relates to claims adjuster responsibilities, because "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." A claims adjuster resume example shows how detail oriented is used in the workplace: "worked in conjunction with litigation department and provided detailed reports with recommendations on settling litigated files. "
Interpersonal skills. For certain claims adjuster responsibilities to be completed, the job requires competence in "interpersonal skills." The day-to-day duties of a claims adjuster rely on this skill, as "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." For example, this snippet was taken directly from a resume about how this skill applies to what claims adjusters do: "demonstrate a high level of proficiency in claim file management, work effectiveness, interpersonal skills and customer service. "
The three companies that hire the most claims adjusters are:
- Sedgwick LLP277 claims adjusters jobs
- Progressive264 claims adjusters jobs
- USAA37 claims adjusters jobs
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Compare different claims adjusters
Claims adjuster vs. Field investigator
A field investigator is responsible for collecting information and evidence to support ongoing investigations of law enforcement agencies. Field investigators analyze the occurrence and connections of criminal activities by gathering related cases and coordinating with scene witnesses. They also validate the information by conducting surveillance operations and coordinating with law professionals. A field investigator may also work for private clients, updating them regularly for the progress, and informing them of additional actions as needed to solve complicated cases.
While similarities exist, there are also some differences between claims adjusters and field investigator. For instance, claims adjuster responsibilities require skills such as "insurance carriers," "auto claims," "customer service," and "litigation." Whereas a field investigator is skilled in "excellent time management," "background checks," "mental health," and "criminal justice." This is part of what separates the two careers.
Field investigators tend to make the most money working in the insurance industry, where they earn an average salary of $41,014. In contrast, claims adjusters make the biggest average salary, $49,979, in the insurance industry.On average, field investigators reach similar levels of education than claims adjusters. Field investigators are 4.9% more likely to earn a Master's Degree and 0.3% more likely to graduate with a Doctoral Degree.Claims adjuster vs. Claims service representative
Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim. Also, they determine whether it is worth arranging a settlement and make sure all settlement claims are managed quickly. In addition to evaluating accidents and claims, they renew customer policies based on their history. Qualifications for the job include a firm knowledge of overall company policy, computer literacy, and excellent customer service.
In addition to the difference in salary, there are some other key differences worth noting. For example, claims adjuster responsibilities are more likely to require skills like "auto claims," "litigation," "xactimate," and "multitasking." Meanwhile, a claims service representative has duties that require skills in areas such as "phone calls," "claims process," "strong customer service," and "csr." These differences highlight just how different the day-to-day in each role looks.
Claims service representatives may earn a lower salary than claims adjusters, but claims service representatives earn the most pay in the government industry with an average salary of $38,986. On the other hand, claims adjusters receive higher pay in the insurance industry, where they earn an average salary of $49,979.Average education levels between the two professions vary. Claims service representatives tend to reach similar levels of education than claims adjusters. In fact, they're 0.9% less likely to graduate with a Master's Degree and 0.3% less likely to earn a Doctoral Degree.Claims adjuster vs. Senior claims representative
A senior claims representative serves as a client's primary point of contact when processing insurance claims. Their responsibilities include meeting with clients to identify their needs, gathering and verifying documentation, conducting investigations to determine the validity of insurance claims, liaising with external parties, and negotiating the amount of compensation. Furthermore, as a senior claims representative, it is essential to lead and serve as a mentor to junior claims representatives, all while implementing the company's policies and regulations, including its vision and mission.
Some important key differences between the two careers include a few of the skills necessary to fulfill the responsibilities of each. Some examples from claims adjuster resumes include skills like "auto claims," "multitasking," "insurance coverage," and "insurance policy," whereas a senior claims representative is more likely to list skills in "automobile claims," "claims process," "coverage analysis," and "sr."
Senior claims representatives typically earn similar educational levels compared to claims adjusters. Specifically, they're 0.6% less likely to graduate with a Master's Degree, and 0.1% less likely to earn a Doctoral Degree.Claims adjuster vs. Senior claims examiner
Senior claims examiners review, assess, and process the insurance claims of their clients. The examiners provide recommendations for claims-related resolution. It is their responsibility to examine and authorize the investigation of insurance claims as conducted by insurance adjusters. They check the claims and the insurance policies to ensure that all the information is right. During the settlement, they are expected to be careful in keeping the records with details of the process.
Types of claims adjuster
Updated June 25, 2024
