Claims Adjusters, Examiners, and Investigators Occupation Details

General Job Description and Education/Training Levels for Claims Adjusters, Examiners, and Investigators

The main tasks and work activities of Claims Adjusters, Examiners, and Investigators are to calculate data to inform organizational operations, prepare legal or investigatory documentation, advise others on legal or regulatory compliance matters, collect evidence for legal proceedings. In general, for the Claims Adjusters, Examiners, and Investigators, writing, reading Comprehension, critical Thinking, speaking and other 13 skills are required.

Claims Adjusters, Examiners, and Investigators Job Description
Education	Most of these occupations require a four-year bachelor's degree, but some do not.
Related Experience	A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
Job Training	Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
Example	Many of these occupations involve coordinating, supervising, managing, or training others. Examples include real estate brokers, sales managers, database administrators, graphic designers, chemists, art directors, and cost estimators.

The following chart shows the education/training levels for Claims Adjusters, Examiners, and Investigators jobs. 14.22% of Claims Adjusters, Examiners, and Investigators have High School Diploma (or the equivalent) and 2.02% of Claims Adjusters, Examiners, and Investigators have Post-Secondary Certificate.

Less than a High School Diploma

0.00%

High School Diploma (or the equivalent)

14.22%

Post-Secondary Certificate

2.02%

Some College Courses

6.44%

Associate's Degree (or other 2-year degree)

10.59%

Bachelor's Degree and Above

66.73%

Tasks and Work Activities of Claims Adjusters, Examiners, and Investigators

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.
Pay and process claims within designated authority level.
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
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.
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
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.
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
Present cases and participate in their discussion at claim committee meetings.
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Confer with legal counsel on claims requiring litigation.
Report overpayments, underpayments, and other irregularities.
Communicate with reinsurance brokers to obtain information necessary for processing claims.
Supervise claims adjusters to ensure that adjusters have followed proper methods.
Conduct detailed bill reviews to implement sound litigation management and expense control.
Prepare reports to be submitted to company's data processing department.
Examine claims forms and other records to determine insurance coverage.
Analyze information gathered by investigation and report findings and recommendations.
Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
Prepare report of findings of investigation.

Getting InformationObserving, receiving, and otherwise obtaining information from all relevant sources.
Resolving Conflicts and Negotiating with OthersHandling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
Interacting With ComputersUsing computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
Communicating with Supervisors, Peers, or SubordinatesProviding information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
Identifying Objects, Actions, and EventsIdentifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
Evaluating Information to Determine Compliance with StandardsUsing relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
Making Decisions and Solving ProblemsAnalyzing information and evaluating results to choose the best solution and solve problems.
Processing InformationCompiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
Documenting/Recording InformationEntering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
Organizing, Planning, and Prioritizing WorkDeveloping specific goals and plans to prioritize, organize, and accomplish your work.

Calculate data to inform organizational operations.
Prepare legal or investigatory documentation.
Advise others on legal or regulatory compliance matters.
Collect evidence for legal proceedings.
Gather financial records.
Verify application data to determine program eligibility.
Negotiate agreements to resolve disputes.
Investigate legal issues.
Pay charges, fees, or taxes.
Implement financial decisions.
Advise others on financial matters.
Maintain data in information systems or databases.
Prepare financial documents.
Verify accuracy of records.
Present business-related information to audiences.
Interview witnesses, suspects, or claimants.
Report information to managers or other personnel.
Confer with others about financial matters.
Supervise employees.
Examine financial records.

Skills and Abilities for Claims Adjusters, Examiners, and Investigators

WritingCommunicating effectively in writing as appropriate for the needs of the audience.
Reading ComprehensionUnderstanding written sentences and paragraphs in work related documents.
Critical ThinkingUsing logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
SpeakingTalking to others to convey information effectively.
Active ListeningGiving 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.
NegotiationBringing others together and trying to reconcile differences.
Judgment and Decision MakingConsidering the relative costs and benefits of potential actions to choose the most appropriate one.
Complex Problem SolvingIdentifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Social PerceptivenessBeing aware of others' reactions and understanding why they react as they do.
MonitoringMonitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
Service OrientationActively looking for ways to help people.
CoordinationAdjusting actions in relation to others' actions.
Active LearningUnderstanding the implications of new information for both current and future problem-solving and decision-making.
PersuasionPersuading others to change their minds or behavior.
MathematicsUsing mathematics to solve problems.
Time ManagementManaging one's own time and the time of others.

Written ComprehensionThe ability to read and understand information and ideas presented in writing.
Oral ComprehensionThe ability to listen to and understand information and ideas presented through spoken words and sentences.
Oral ExpressionThe ability to communicate information and ideas in speaking so others will understand.
Deductive ReasoningThe ability to apply general rules to specific problems to produce answers that make sense.
Problem SensitivityThe ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
Written ExpressionThe ability to communicate information and ideas in writing so others will understand.
Speech ClarityThe ability to speak clearly so others can understand you.
Speech RecognitionThe ability to identify and understand the speech of another person.
Inductive ReasoningThe ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
Near VisionThe ability to see details at close range (within a few feet of the observer).
Information OrderingThe ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
Number FacilityThe ability to add, subtract, multiply, or divide quickly and correctly.
Category FlexibilityThe ability to generate or use different sets of rules for combining or grouping things in different ways.
Flexibility of ClosureThe ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material.
Speed of ClosureThe ability to quickly make sense of, combine, and organize information into meaningful patterns.
Selective AttentionThe ability to concentrate on a task over a period of time without being distracted.
Mathematical ReasoningThe ability to choose the right mathematical methods or formulas to solve a problem.
Far VisionThe ability to see details at a distance.
Perceptual SpeedThe ability to quickly and accurately compare similarities and differences among sets of letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object.

Desktop computerse.g. Desktop computers
Notebook computerse.g. Notebook computers
Personal computerse.g. Personal computers
Personal digital assistant PDAs or organizerse.g. Personal digital assistants PDA
Scannerse.g. Scanners
Tablet computerse.g. Tablet computers
Portable data input terminalse.g. Data collectors
Desktop computerse.g. Desktop computers
Automotive computer systemse.g. Event data recorders
Portable data input terminalse.g. Field computers
Portable data input terminalse.g. Handheld computers
Measuring wheels for distancee.g. Measure markers
Portable data input terminalse.g. Mobile wireless handheld communication devices
Personal digital assistant PDAs or organizerse.g. Personal digital assistants PDA
Theodolitese.g. Total stations

Customer and Personal ServiceKnowledge 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 LanguageKnowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
MathematicsKnowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Law and GovernmentKnowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
ClericalKnowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
Computers and ElectronicsKnowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
Administration and ManagementKnowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

Claims Adjusters, Examiners, and Investigators Occupation Detailed Description

Tasks and Work Activities of Claims Adjusters, Examiners, and Investigators

Skills and Abilities for Claims Adjusters, Examiners, and Investigators