Claims Adjuster Job Profile

Claims adjusters are the people who investigate insurance claims. This is an often complex job, where experience and understanding of claims issues is extremely important.

The work environment

Claims adjusters work in what is generally a case management environment, because each claim is literally legally a case. The entitlements of claimants to compensation is set out in a legal format, an insurance policy. Each claim must be assessed on its merits, and that can take a lot of work in some cases, because claims adjusters must confirm the facts of the matter before approving payment.

The claims adjuster's role is also balanced by the need to protect against insurance fraud. The claims adjuster is the insurance company's first line of defense against fraud, and adjusters are expected to be very thorough in their examinations of claims for this reason. That adds several dimensions to the examination of claims.

The obligations on the claims adjuster are several:

  • To discharge the obligations of the policy correctly in legal terms.
  • To gather information that will verify the decisions regarding claims.
  • To protect the insurer against fraud.
  • To act as a representative of the insurer to clients who may be in distress.

This isn't a particularly easy job in some cases. Insurance claims can generate large amounts of information, in some cases highly technical, all of which has to be assessed. Although the adjuster does get expert support from professionals where required in these issues, the workload can be both difficult and high. The claims adjuster must sometimes obtain corroborative evidence to support a decision, or to verify information which of itself isn't sufficient.

Among the areas commonly covered by claims adjusters are:

  • Accidents
  • Property damage
  • Liability
  • Injury

The claims adjuster must determine:

  • Whether the policy covers the claim
  • The amount payable
  • Any issues affecting payment

Claims adjusters are also responsible for the processing of claims in a timely manner. This is a formal process. It's also important, because despite the level of detail and investigation required, it's necessary for the insurer to deal with claims in a reasonable time frame. Failure to do so may be considered a breach of the insurer's legal obligations.

Salaries: The salary bandwidth for claims adjusters is $31,000 to $90,000.

Hours: Hours required may be flexible, because of the nature of the work and the need to interview clients and other parties when available.

The career environment

Skills required

Claims adjusters require particularly high levels of skills in these areas:

Communications: The claims adjuster must also interview claimants and witnesses. The claimants may be in significant financial or personal difficulties, so the claims adjuster has to be an excellent communicator, tactful, and above all understanding.

Analytical skills: Analysis of claims can be very demanding, and as the career progresses, the degree of difficulty increases.

Problem solving skills: The work of claims adjusters can include a range of problems related to policies and payment issues.

Claims adjusters may choose to specialize in a particular field of insurance. This can be a good move, because of the nature of the work which frequently requires high levels of experience. Career progression is closely linked to experience levels and proven expertise.