Claims adjuster jobs description: U.S. Bureau of Labor Statistics

Claims Adjuster job description template [Ready to Use]

Use this claims adjuster job description template to advertise your open roles. Feel free to modify responsibilities and requirements based on your specific needs. An alternative title for this role is insurance adjuster.

What is a claims adjuster?

A claims adjuster examines insurance claim liability for property damage (e.g. homes, offices, or automobiles) or personal injuries. They either work in-house for insurance companies or as external contractors.

What does a claims adjuster do?

Claims adjusters collect information from various sources to determine insurance liability based on the extent of property or personal damage. They interview claimants and witnesses, and often consult with specialists, such as policyholders and engineers. After that, they estimate if the damage is covered by insurance policies and calculate payments.

Claims adjuster job duties include:

• Examining property damage and physical injuries
• Preparing and processing claim reports
• Negotiating payments with claimants 

What skills are needed to be a claims adjuster?

Claims adjusters usually have a degree in insurance, finance, or relevant field. Their skills include competency in appraisal software and MS Office. The role also requires good interpersonal skills and experience in writing reports. 

When crafting your own claims adjuster job description, be sure to include these requirements.

Job brief

We are looking for an experienced claims adjuster to join our team.

On a daily basis, you’ll handle and process insurance claims. You’ll examine property damages and physical injuries to calculate claim liability. You’ll achieve this by gathering information from various sources, for example, through interviewing claimants, witnesses, or specialists (e.g. policyholders, physicians, or engineers). To succeed in this role, you must have strong analytical thinking and excellent writing skills.

If you are a reliable person with a strong work ethic, we’d like to hear from you.

Responsibilities

• Inspect property and physical damage
• Analyze complex information from different sources
• Examine claim liability 
• Prepare and process claim reports
• Consult with specialists (e. g. physicians, engineers)
• Calculate benefits and payments
• Negotiate settlements with claimants
• Examine police reports, videos from surveillance cameras or audio if applicable
• Support attorneys to defend the company in case of contestation

Requirements and skills

• Previous experience as a claims adjuster or similar role
• Working experience in using appraisal software
• Strong analytical and mathematical skills
• Experience in writing detailed reports
• A compassionate and resilient personality
• High school diploma
• Degree in Insurance, Finance or similar field is a plus

Frequently asked questions

What does a Claims Adjuster do?

Claims Adjusters examine claims forms to determine insurance coverage. In addition, they review police reports, medical treatment records, or physical property damage to estimate the extent of liability for losses that a person may have incurred.

What are the duties and responsibilities of a Claims Adjuster?

Claims Adjusters ensure that one’s insurance company pays for any losses you suffer. They can inspect property damage or personal injury claims and collect information from all parties involved. They then determine how much they should pay each, interviewing witnesses and examining damage when necessary.

What makes a Good Claims Adjuster?

Good Claims Adjusters are patient and professional. They treat customers with respect, striving to communicate openly, even when it’s difficult or takes time for them. A Claims Adjuster doesn’t need complex computer skills; however, they do need basic knowledge of using a computer.

Who does a Claims Adjuster work with?

Claims Adjusters work with Cost Analysts to figure out how much they should pay a particular client concerning their claim. In addition, these Analysts give insight into how much a specific factor might affect the total cost of the venture.

Claims Adjuster Job Descriptions, Salary, and Interview Questions

A claims adjuster is responsible for investigating, assessing, and resolving insurance claims. They work with customers, insurance companies, and agents to ensure that all claims are handled fairly and in accordance with company policy.

The majority of claims adjusters work for insurance companies, although some may work for third-party claim processing companies. They typically have a college degree in business, economics, accounting, or a related field.

Sample

job description #1

The Claims Adjuster handles low to mid-range complexity claims that will consist of a direct investigation of the facts of loss, evaluation of coverages, damages, liability, and negotiation of claims to a proper conclusion. May be involved with litigated files for experience and developmental purposes.

Key responsibilities

• Determines policy status and coverage; reviews appropriate policies and endorsements for coverage, limits, and deductibles; immediately notify manager of any claim that may be outside of assigned scope of handling, level, or authority
• Makes prompt contact with policyholders, claimants, witnesses, and other parties involved in the loss to set expectations, develop an action plan, and perform an initial exposure assessment
• Conducts an investigation to determine coverage, liability, and damages, including recorded statements and coordination of field inspections or experts when necessary based on Department Best Practices
• Ensures regular and timely follow-up and brings claims to prompt and appropriate conclusion while keeping the customer informed throughout the life cycle of the claim process
• Ability to scope and estimate real property, personal property, and time element damages using company approved software applications
• Identifies any subrogation potential and liability exposures and consults with supervisor
• Performs all claims related functions with guided assistance and input from their supervisor
• Maintains electronic records that accurately and thoroughly document all file handling activity
• May be called upon to perform additional duties as directed
• Reasonable and predictable attendance is required

Minimum experience/education

• 2 years or more of claim experience
• High school diploma or equivalent required. Post-secondary education preferred
• Current adjuster licensure or the ability to obtain within 90 days of hire
• Basic computer skills and Microsoft and Google applications preferred

Communication and collaboration skills

• Professional oral and written communication skills are critical to the success of this position. All claims service must be handled with tact, diplomacy and courtesy at all times
• Must be able to collaborate and develop strong team relationships with associates from within and outside the Claims Department
• Customer centric with exceptional customer service skills

Technical knowledge

Must have comprehensive knowledge and understanding of insurance policies and endorsements, as well as the ability to understand complex documents, contracts, and other legal documents.

Problem solving

Gather facts and draw conclusions, interpret complex requirements/issues and work independently. The individual must be able to identify and implement key opportunities while researching potential solutions.

Sample

job description #2

Job overview

ABC Company is looking for an Auto Claim Adjuster who will be responsible for evaluating and investigating policy coverage, liability, and damages while providing a high level of customer service when assisting customers and claimants in a timely manner with inquiries regarding the associated claim. The ideal candidate has about 1 to 2 years of prior auto claim adjusting experience, is able to communicate effectively, has excellent negotiation and investigative skills, and is able to perform basic math calculations while managing time well to meet time-sensitive deadlines, is well organized, and displays critical thinking skills.

Responsibilities and duties

• Evaluate and investigate policy coverage, liability, and damages in a timely manner following a set of general claim and statutory guidelines
• Assist customers and claimants with problems or questions regarding claims by phone or through written correspondence, while providing a high level of customer service
• Establish initial reserves for all potential exposures and adjust as appropriate throughout the claim
• Establish and maintain appropriate management of assigned inventory following company guidelines
• Conduct thorough investigations including but not limed to, obtaining necessary documents, forms, and witness statements, as well conducting recorded statements
• Ensure timely assignment of appraisals using company approved vendors, provide rental vehicles to claimants as needed, and be able to determine accident-related damages
• Communicate with involved parties and negotiate appropriate settlements with claimants, insureds, and attorneys within approved payment authority
• Recognize recovery opportunities regarding total loss and salvage, as well as subrogation
• Other duties as assigned

Qualifications

• High School Diploma, GED or equivalent, required
• Bachelor degree in Business or another related field or equivalent work experience, preferred
• INS or other insurance related course, preferred
• Proficient PC and Windows skills
• Proven ability to provide excellent customer service
• Ability to perform basic math calculations – addition, subtraction, multiplication, & division – as well as calculation of averages and percentages

Experience

• 1 – 2 years of auto claim adjusting experience or similar work experience
• Nonstandard Auto experience, a plus

Knowledge, skills, & abilities

• Effective written and verbal communication skills as well as negotiation and investigative skills
• Excellent time management, organizational, and critical thinking skills
• Superb attention to detail to ensure accuracy while meeting time-sensitive deadlines
• Strong ability to prepare and present accurate, reliable, and factual reports with recommendations to appropriate parties
• Ability to be flexible in a fast-paced environment as well as understand and follow oral and/or written policies, procedures, and instructions
• Discretion when handling confidential information
• Exhibit a comfort level working with key people at all levels within an organization

Sample

job description #3

The Claims Adjuster performs duties to manage a caseload of low to moderately complex worker’s compensation claims. This consists of determining compensability, setting reserves, and approving payments, in accordance with industry/company Claims Best Practices. Analyzes and interprets statutes and regulations applicable to case facts in order to render appropriate legal and ethical decisions. Analyzes legal issues and directs legal strategy. Manages claims in a prompt and thorough manner from inception through closure. Aggressively negotiates the settlement of claims.

Essential duties and responsibilities:

• With general management oversight, works within assigned authority limits on claims reflecting a low to moderate degree of technical complexity and severity
• Analyzes case facts, applies appropriate statutes and regulations, and identifies possible fraud and abuse, in determining compensability
• Analyzes case facts to establish timely and accurate case reserves. Requires knowledge of medical disabilities and related costs, as well as judgment of extent of disability. Applies knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
• Completes detailed settlement analysis and recommends appropriate settlement value, utilizing knowledge of appropriate Workers Compensation insurance principles and laws, subrogation recoveries, offsets and deductions, claim and disability duration, cost containment principles; including medical management practices, Social Security, and Medicare application procedure as applicable
• Ensures quality medical management by applying appropriate medical concepts, and by interpreting and applying appropriate statutes and regulations. Requires independent judgment to render accurate decisions
• Proactively manages claim litigation process. Manages legal issues that can be adjudicated without the use of a defense attorney. Directs legal strategy and participates in preparation of the case for litigation. Provides testimony at hearings as needed
• Analyze physician reports for content and accuracy to ensure prompt and appropriate processing of medical and indemnity benefits
• Evaluates, prepares, and manages cases of possible permanent partial disability
• Manages dedicated accounts as assigned. Participates in telephonic claim reviews
• Other duties may be assigned

Job requirements:

• Excellent written and oral communication, listening, interpersonal, customer service and telephone skills
• Proficient in the use and knowledge of MS Office software, with the ability to type at a minimum of 35 wpm
• Demonstrated knowledge of Workers’ Compensation laws and ability to adhere to statutes, regulations and company policies and practices, as well as related claim management procedures/protocols. Comprehensive knowledge of AMA Guides to the Evaluation of Permanent Impairment and medical terminology
• Self-motivated with excellent analytical, problem solving and decision-making skills and ability to deal professionally with people in stressful situations. Ability to maintain confidentiality. Conduct business at all times with the highest standards of personal, professional and ethical conduct
• If State Certification is required, must meet requirements and obtain certification within state mandated time frame
• Must have High School Diploma or GED equivalent
• Must possess 2-5 years of related claims experience
• Ability to participate in job related internal and external training and pass any tests within the set guidelines
• Bachelor’s degree or equivalent business experience preferred
• WCCP certification preferred
• Current Experienced Claims Adjuster Designation preferred
• Working knowledge of an imaged claims environment preferred
• Bilingual in English and Spanish preferred
• An equivalent combination of education and experience may be substituted for the requirements listed above

Average salary and compensation

The average salary for a claims adjuster is $50,850. They may receive additional pay for overtime or travel. They may also receive a benefits package, which includes health insurance, dental insurance, and a 401(k) plan.

Sample interview questions

• What types of customers have you worked with in the past?
• How comfortable are you with approaching customers on the phone?
• Have you had to use your negotiation skills while working for a previous employer? How did it go?
• How do you feel about working overtime or traveling overnight when necessary?
• Do you think that your previous experience qualifies you to work as a claims adjuster? If not, what would you need to do to be qualified?
• What education and/or experience do you have in the insurance industry?
• What was the most difficult claim that you ever had to investigate and why?
• What is your understanding of the insurance claims process?
• If you were hired as a claims adjuster, what do you think would be your biggest challenge?
• Have you ever had to file a claim with an insurance company? If so, how was the process for you?
• What is your understanding of the insurance adjuster’s role in the industry?

Job description of a claims adjuster

I.

General provisions

under the advanced training program

or

secondary vocational education (non-core) under the training program for mid-level specialists and additional professional education under the advanced training program, professional retraining program.

2. At least one year of practical experience in the field of settlement of insured events (losses).

3. Appointment and dismissal of a claims adjuster is made by order of the head of the organization.

4. Claims adjuster must know:

4.1. Fundamentals of the civil legislation of the Russian Federation

4.2. Legislation of the Russian Federation in the areas of consumer protection, personal data, counteraction to the legalization (laundering) of proceeds from crime

4.3. Insurance legislation of the Russian Federation

4.4. Standards of a self-regulatory organization in the financial market

4.5. Theory and practice of insurance

4. 6. Fundamentals of settling an insured event

4.7. Composition, completeness, principles of production (construction), inspected objects of insurance; arrangement of the object, principles of its functioning

4.8. The procedure for attracting specialized experts or expert organizations

4.9. Forms of documents used for the inspection, the procedure for their preparation or completion

4.10. Document flow

4.11. Labor protection requirements

4.12. ___________________________________________________________

5. The Claims Adjuster reports directly to ____________________.

6. During the absence of a claims adjuster (holiday, illness, etc.), his duties are performed by a duly appointed person. This person acquires the relevant rights and is responsible for their proper implementation.

7. ________________________________________________________________

II. Responsibilities

The duties of a claims adjuster include:

1. Consideration of applications from persons for receiving insurance payments:

— Identification of policyholders, insured persons, beneficiaries or their representatives who applied for insurance payments

— Consulting and providing necessary information on the settlement of insured events

— Acceptance of documents upon the occurrence of events that have signs of an insured event

— Checking the completeness of the submitted documents and compliance with the requirements for paperwork

— Registration of appeals and documents on the settlement of insured events

— Informing about the provision of documents insufficient for making a decision on the implementation of insurance payments, and (or) improperly executed documents

— Making requests to the competent authorities on the settlement of insured events

— Checking the availability of a reinsurance contract for a declared event that has signs of an insured event

— Entering information into the database of an insurance organization

2. Determining the cause of the occurrence of a declared event that has signs of an insured event:

— Informing policyholders, insured persons, beneficiaries , or their representatives on consideration of documents for insurance payment

— Inspection of damaged insured property, examination of the insured person to determine the cause of the occurrence of an event that has signs of an insured event

— Interaction with experts to conduct additional specialized examinations and examinations to establish the cause of an event that has signs of an insured event

— Checking an event that has signs of an insured event for the likelihood of fraud

— Drawing up documents (acts or reports) containing the results of the inspection object of insurance

— Processing requests for the provision of documents and information to establish the cause of the occurrence of an event that has signs of an insured event

— Preparation of an opinion on the most probable cause of an event that has signs of an insured event

3. Settlement of an insured event (loss):

— Informing policyholders, insured persons, beneficiaries, or their representatives on the settlement of insured events

— Interaction with loss assessment experts

— Checking for the possibility of fraud of an insured event that has the characteristics of an insured event

— Analysis of expert opinions

— Preparation of an opinion on recognition or non-recognition as an insured event (loss) of an event that has signs of an insured event

— Calculation of the amount of insurance payment for an insured event

— Preparation of a document (conclusion, decision, act) the amount of the insurance payment based on the calculations

— Determining the possibility of filing claims for damages, preparing information and documents for filing claims for damages

— Compliance with the terms and procedure for making a decision on making an insurance payment

— Drawing up documents for making an insurance payment

— Entering information into the database of an insurance company

III.

Rights

The claims adjuster has the right to:

1. Request and receive the necessary information, as well as materials and documents.

2. Improve qualifications, undergo retraining (retraining).

3. Take part in the discussion of issues that are part of his functional duties.

4. Make suggestions and comments on the improvement of activities in the assigned area of ​​work.

5. Require the management of the organization to provide assistance, including the provision of organizational and technical conditions and execution of the established documents necessary for the performance of official duties.

6._______________________________________________________________

IV. Responsibility

Claims adjuster is liable:

1. For improper performance or non-performance of their duties under this job description – to the extent determined by the current labor legislation of the Russian Federation.

2. For offenses committed in the course of carrying out their activities – within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.

3. For causing material damage – within the limits determined by the current labor and civil legislation of the Russian Federation.

4. ____________________________________________________________________

This job description was developed in accordance with the provisions (requirements) of the Labor Code of the Russian Federation dated December 30, 2001 No. 197 FZ (Labor Code of the Russian Federation) (as amended and supplemented), professional standard “ Insurance Specialist “approved by order of the Ministry of Labor and Social Protection of the Russian Federation of July 6, 2020. No. 404n and other normative legal acts regulating labor relations.

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Claims Manager Job Description :: bomemlusean

02.01.2017 22:55

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