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.

  • Examine claims forms and other records to determine insurance coverage.
  • Analyze information gathered by investigation and report findings and recommendations.
  • 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.
  • 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.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Pay and process claims within designated authority level.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • 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.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Collect evidence to support contested claims in court.
  • Confer with legal counsel on claims requiring litigation.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Present cases and participate in their discussion at claim committee meetings.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.
  • Report overpayments, underpayments, and other irregularities.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.
  • Obtain credit information from banks and other credit services.
  • Attend mediations or trials.
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.
Work Context
  • Telephone
  • Electronic Mail
  • Letters and Memos
  • Frequency of Decision Making
  • Contact With Others
  • Importance of Being Exact or Accurate
  • Impact of Decisions on Co-workers or Company Results
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Work Activities
  • Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
  • Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
  • Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
  • Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
  • Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
  • Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
  • Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
  • Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
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Detailed Work Activities
  • Calculate data to inform organizational operations.
  • Investigate legal issues.
  • Prepare legal or investigatory documentation.
  • Estimate costs of goods or services.
  • Appraise property values.
  • Interview witnesses, suspects, or claimants.
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Knowledge

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.
English Language
  • Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
Law and Government
  • Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
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Skills

Reading Comprehension
  • Understanding written sentences and paragraphs in work related documents.
Critical Thinking
  • Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Active Listening
  • Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Speaking
  • Talking to others to convey information effectively.
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Abilities

Oral Comprehension
  • The ability to listen to and understand information and ideas presented through spoken words and sentences.
Written Comprehension
  • The ability to read and understand information and ideas presented in writing.
Oral Expression
  • The ability to communicate information and ideas in speaking so others will understand.
Deductive Reasoning
  • The ability to apply general rules to specific problems to produce answers that make sense.
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Personality

People interested in this work like activities that include ideas, thinking, and figuring things out.
They do well at jobs that need:
  • Achievement/Effort
  • Persistence
  • Initiative
  • Leadership
  • Cooperation
  • Concern for Others
  • Social Orientation
  • Self Control
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Technology

You might use software like this on the job:

Computer aided design CAD software
  • 4n6xprt Systems StiffCalcs Hot Technology
  • PhotoModeler Hot Technology
  • MapScenes Pro Hot Technology
  • MapScenes Evidence Recorder Hot Technology
  • ARSoftware WinSMAC Hot Technology
  • Visual Statement Investigator Suite Hot Technology
  • CAD Zone Insurance Hot Technology
Presentation software
  • Microsoft PowerPoint Hot Technology
Office suite software
  • Microsoft Office Hot Technology
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