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Become An Insurance Specialist

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Working As An Insurance Specialist

  • Identifying Objects, Actions, and Events
  • Interacting With Computers
  • Getting Information
  • Documenting/Recording Information
  • Processing Information
  • Unpleasant/Angry People

  • Mostly Sitting

  • Make Decisions

  • Stressful

  • $65,171

    Average Salary

What Does An Insurance Specialist Do

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and, if so, how much.

Duties  

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants’ doctors or employers to get additional information on questionable claims
  • Confer with legal counsel on claims when needed
  • Negotiate settlements
  • Authorize payments

Claims adjusters, appraisers, examiners, and investigators have varying duties, depending on the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable. 

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile.

Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. They may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

Adjusters gather information—including photographs and statements, either written or recorded on audio or video—and put together a report for claims examiners to evaluate. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer’s position.

Some claims adjusters work as self-employed public adjusters. Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant. They are paid a percentage of the settled claim.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure claimants and adjusters followed proper guidelines. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies, to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from overstated claims of damage to vehicles to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does anything that would be ruled out by injuries stated in the claim.

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How To Become An Insurance Specialist

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher level positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

The varying types of work in these occupations can require different backgrounds or different college coursework. For example, a business or an accounting background might be best for someone who wishes to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have the formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Most insurance companies prefer to hire people trained as law enforcement officers, private investigators, claims adjusters, or examiners, because these workers have good interviewing and interrogation skills.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims, under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must both evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. 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. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

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Insurance Specialist Jobs

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Insurance Specialist Career Paths

Insurance Specialist
Accounts Receivable Specialist Accounts Receivable Supervisor
Accounts Receivable Manager
6 Yearsyrs
Operations Manager Real Estate Agent Insurance Sales Agent
Agency Manager
6 Yearsyrs
Claim Specialist Account Manager Regional Sales Director
Area Vice President
12 Yearsyrs
Accounts Receivable Specialist Accountant Human Resources Coordinator
Benefits Manager
8 Yearsyrs
Account Executive Office Manager Business Office Manager
Business Office Director
9 Yearsyrs
Specialist Account Manager Billing Specialist
Business Office Manager
8 Yearsyrs
Insurance Coordinator Reimbursement Specialist Client Manager
Client Account Manager
6 Yearsyrs
Account Manager Billing Specialist Collections Specialist
Collections Manager
5 Yearsyrs
Scheduler Account Representative Territory Sales Manager
Commercial Account Manager
8 Yearsyrs
Operations Manager Underwriter Commercial Lines Underwriter
Commercial Lines Manager
9 Yearsyrs
Account Manager Operations Manager Property Manager
Commercial Property Manager
7 Yearsyrs
Accounts Payable Clerk Collections Specialist Loss Mitigation Specialist
Loss Control Manager
7 Yearsyrs
Medical Biller Coder Claim Processor Provider Relations Representative
Manager, Provider Relations
9 Yearsyrs
Reimbursement Specialist Collector Billing Specialist
Medical Billing Manager
6 Yearsyrs
Reimbursement Specialist Case Manager Patient Care Manager
Medical Manager
6 Yearsyrs
Claim Specialist Service Specialist Service Supervisor
Patient Services Manager
8 Yearsyrs
Specialist Paralegal Office Manager
Practice Manager
9 Yearsyrs
Account Executive Operations Manager Property Manager
Properties Supervisor
6 Yearsyrs
Case Manager Unit Manager Risk Manager
Risk And Insurance Manager
8 Yearsyrs
Medical Coder Auditor Assistant Vice President
Risk Manager
8 Yearsyrs
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Do you work as an Insurance Specialist?

Help others decide if this is a good career for them

Average Length of Employment
Claim Specialist 3.2 years
Insurance Clerk 3.1 years
Insurance Biller 2.9 years
Billing Specialist 2.9 years
Insurance Analyst 2.8 years
Top Employers Before
Cashier 4.7%
Teller 4.3%
Internship 3.1%
Secretary 2.5%
Specialist 2.4%
Top Employers After
Specialist 4.2%
Teller 3.9%
Cashier 3.7%
Owner 2.5%
Supervisor 2.5%

Do you work as an Insurance Specialist?

Insurance Specialist Demographics

Gender

Female

77.1%

Male

21.4%

Unknown

1.5%
Ethnicity

White

61.3%

Hispanic or Latino

16.5%

Black or African American

11.9%

Asian

6.8%

Unknown

3.4%
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Foreign Languages Spoken

Spanish

68.3%

French

6.4%

Russian

3.0%

Italian

3.0%

German

2.5%

Carrier

2.0%

Arabic

2.0%

Vietnamese

1.5%

Mandarin

1.5%

Albanian

1.5%

Portuguese

1.5%

Swedish

1.0%

Korean

1.0%

Cantonese

1.0%

Chinese

1.0%

Polish

1.0%

Lithuanian

0.5%

Romanian

0.5%

Hindi

0.5%

Khmer

0.5%
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Insurance Specialist Education

Schools

University of Phoenix

26.3%

Ashford University

7.3%

Kaplan University

6.4%

Liberty University

5.5%

Strayer University

4.7%

Florida State University

4.3%

Walden University

4.0%

Southern New Hampshire University

4.0%

Greenville Technical College

4.0%

Baker College

3.6%

Texas State University

3.3%

American InterContinental University

3.3%

Michigan State University

3.1%

Middle Tennessee State University

3.1%

University of Memphis

3.1%

Remington College

2.8%

Tyler Junior College

2.8%

The Academy

2.8%

Capella University

2.8%

Arizona State University

2.6%
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Majors

Business

30.1%

Health Care Administration

15.3%

Psychology

5.2%

Accounting

4.7%

Criminal Justice

4.5%

Medical Assisting Services

4.3%

Insurance

4.0%

Nursing

3.6%

Management

3.6%

General Studies

3.0%

Finance

2.9%

Communication

2.9%

Marketing

2.8%

Education

2.6%

Computer Information Systems

2.0%

Liberal Arts

1.8%

Political Science

1.8%

English

1.7%

Human Resources Management

1.7%

Computer Science

1.6%
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Degrees

Other

32.6%

Bachelors

31.6%

Associate

14.3%

Masters

9.9%

Certificate

6.7%

Diploma

2.6%

Doctorate

1.3%

License

1.0%
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Job type you want
Full Time
Part Time
Internship
Temporary

Real Insurance Specialist Salaries

Job Title Company Location Start Date Salary
Practice Specialist-Insurance Policy Administrat Valuemomentum, Inc. South Plainfield, NJ Sep 20, 2010 $80,000
Pratice Specialist-Insurance Policy Administrati Valuemomentum, Inc. South Plainfield, NJ Sep 20, 2010 $80,000
Property Insurance Specialist Worldwide Facilities, Inc. Johns Creek, GA Sep 26, 2012 $70,000 -
$95,000
Insurance Specialist The W Insurance Marketing Corporation Fremont, CA Oct 01, 2012 $60,000
Insurance Specialist W Insurance Marketing Corporation Fremont, CA Oct 01, 2012 $60,000
Equine Insurance Specialist Yearsley Bloodstock Insurance Lexington Ltd Lexington, KY Jul 10, 2011 $60,000
Insurance Specialist Marsh USA Inc. New York, NY Jul 28, 2014 $55,000 -
$65,000
Insurance Specialist Andritz Inc. Alpharetta, GA Sep 20, 2015 $45,368
Insurance Specialist Andritz Inc. Roswell, GA Nov 08, 2013 $43,500
Insurance Specialist Andritz Inc. Canonsburg, PA Jan 01, 2013 $43,500
Insurance Specialist Andritz, Inc. Roswell, GA Sep 20, 2012 $43,500

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Top Skills for An Insurance Specialist

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  1. Insurance Companies
  2. Customer Service
  3. Phone Calls
You can check out examples of real life uses of top skills on resumes here:
  • Answered and recorded all patient and carrier communication concerning accounts for assigned insurance companies.
  • Clarified insurance requirements to personnel in the field and/or customers when needed providing excellent customer service.
  • Assembled a five member team to audit phone calls and improve sales goals through interactive sales modules for fellow team members.
  • Assist with implementation of Medicaid Managed Care within organization.
  • Initiated prior authorizations for after-hour telephone line by data entering patient information and history into the computer system.

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Top 10 Best States for Insurance Specialists

  1. Alaska
  2. Rhode Island
  3. Michigan
  4. Massachusetts
  5. Ohio
  6. Connecticut
  7. New Jersey
  8. Pennsylvania
  9. Kansas
  10. Texas
  • (34 jobs)
  • (58 jobs)
  • (459 jobs)
  • (433 jobs)
  • (634 jobs)
  • (133 jobs)
  • (361 jobs)
  • (630 jobs)
  • (86 jobs)
  • (984 jobs)

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