Claims Adjuster / Examiner

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.

O*NET reports this occupation under titles such as: Claims Adjuster; Claims Analyst; Claims Examiner; Claims Representative; Claims Specialist; Corporate Claims Examiner; Field Claims Adjuster; General Adjuster; Home Office Claims Specialist; Litigation Claims Representative

Tasks

• Examine claims forms and other records to determine insurance coverage.
• Analyze information gathered by investigation and report findings and recommendations.
• Pay and process claims within designated authority level.
• 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.
• 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.
• 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.
• 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.
• Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
• Confer with legal counsel on claims requiring litigation.
• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
• Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.

Knowledge

• Customer and Personal Service
• English Language
• Administrative
• Mathematics
• Computers and Electronics
• Law and Government
• Administration and Management
• Economics and Accounting

Skills

• Reading Comprehension
• Active Listening
• Critical Thinking
• Speaking
• Writing
• Monitoring
• Active Learning

Abilities

• Written Comprehension
• Oral Comprehension
• Oral Expression
• Deductive Reasoning
• Inductive Reasoning
• Written Expression
• Near Vision
• Problem Sensitivity
• Speech Clarity
• Information Ordering
• Speech Recognition
• Category Flexibility
• Flexibility of Closure
• Mathematical Reasoning
• Number Facility
• Speed of Closure
• Perceptual Speed
• Selective Attention