Claims Adjusters, Examiners, and Investigator Career

Job Description: 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.


Is Claims Adjusters, Examiners, and Investigator the right career path for you?
Take the MyMajors Quiz and find out if it fits one of your top recommended majors!

Claims Adjusters, Examiners, and Investigator Career

What Claims Adjusters, Examiners, and Investigators do:

  • Examine claims forms and other records to determine insurance coverage.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • 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.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Present cases and participate in their discussion at claim committee meetings.
  • 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.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Pay and process claims within designated authority level.
  • Confer with legal counsel on claims requiring litigation.
  • Attend mediations or trials.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Investigate and assess damage to property and create or review property damage estimates.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Report overpayments, underpayments, and other irregularities.
  • Collect evidence to support contested claims in court.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Prepare reports to be submitted to company's data processing department.
  • Obtain credit information from banks and other credit services.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.

What work activities are most important?

Importance Activities

Working with Computers - Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.

Communicating with People Outside the Organization - Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.

Getting Information - Observing, receiving, and otherwise obtaining information from all relevant sources.

Identifying Objects, Actions, and Events - Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.

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.

Documenting/Recording Information - Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.

Resolving Conflicts and Negotiating with Others - Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.

Organizing, Planning, and Prioritizing Work - Developing specific goals and plans to prioritize, organize, and accomplish your work.

Analyzing Data or Information - Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.

Processing Information - Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.

Establishing and Maintaining Interpersonal Relationships - Developing constructive and cooperative working relationships with others, and maintaining them over time.

Updating and Using Relevant Knowledge - Keeping up-to-date technically and applying new knowledge to your job.

Evaluating Information to Determine Compliance with Standards - Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

Interpreting the Meaning of Information for Others - Translating or explaining what information means and how it can be used.

Monitoring Processes, Materials, or Surroundings - Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.

Judging the Qualities of Objects, Services, or People - Assessing the value, importance, or quality of things or people.

Performing for or Working Directly with the Public - Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.

Estimating the Quantifiable Characteristics of Products, Events, or Information - Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.

Performing Administrative Activities - Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.

Developing and Building Teams - Encouraging and building mutual trust, respect, and cooperation among team members.

Scheduling Work and Activities - Scheduling events, programs, and activities, as well as the work of others.

Assisting and Caring for Others - Providing personal assistance, medical attention, emotional support, or other personal care to others such as coworkers, customers, or patients.

Thinking Creatively - Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.

Developing Objectives and Strategies - Establishing long-range objectives and specifying the strategies and actions to achieve them.

Training and Teaching Others - Identifying the educational needs of others, developing formal educational or training programs or classes, and teaching or instructing others.

Monitoring and Controlling Resources - Monitoring and controlling resources and overseeing the spending of money.

Inspecting Equipment, Structures, or Materials - Inspecting equipment, structures, or materials to identify the cause of errors or other problems or defects.

Coordinating the Work and Activities of Others - Getting members of a group to work together to accomplish tasks.

Providing Consultation and Advice to Others - Providing guidance and expert advice to management or other groups on technical, systems-, or process-related topics.

Holland Code Chart for a Claims Adjusters, Examiners, and Investigator