Claims Adjuster Job Description: Top Duties and Qualifications

A Claims Adjuster, or Insurance Adjuster, is responsible for surveying damages to property or investigating personal injuries to decide how much an insurance company should pay to a policyholder. Their duties include meeting with witnesses and the policyholder, reading police reports and traveling to site locations to look at damages up close.

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Claims Adjuster Duties and Responsibilities 

Claims adjusters have varying duties, depending on what type of insurance company they work for. Typical job duties may include: 

  • Investigating, evaluating and settling insurance claims
  • Determining whether the insured’s policy covers the claimed loss
  • Deciding an appropriate amount the company should pay out
  • Ensuring that claims are not fraudulent
  • Contacting claimant’s employers or doctors for additional information if the claim is questionable
  • Conferring with legal counsel when needed
  • Negotiating settlements and authorizing payments

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Claims Adjuster Job Description Examples

 

Example 1

As a Property Adjuster Trainee, you will learn how to estimate damage to residential dwellings and commercial buildings, investigate how losses occur, review insurance contracts and report on your findings. Property Claims Trainees are taught the fundamentals of field property adjusting and is the first step in becoming an adjuster.

Property trainee candidates will work under close supervision to develop skills to effectively investigate, evaluate, negotiate and settle insurance claims in a timely and efficient manner and provide exceptional service to our customers. While most of the time will be spent in a training capacity, which includes shadowing and participating in “ride a longs” of more experienced field adjusters, actual claims will be assigned under close supervision as part of the training process.

Upon completion of the training program, ideal candidates will promote to a Property Claims Representative role. At which time, they will be responsible for visiting different properties investigating, evaluating, negotiating and settling basic Homeowners claims in a timely and efficient manner.

Overnight Travel IS Required FOR THIS Position

Primary Training Responsibilities:
  • Building Materials Training
  • Xactimate Training Program
  • Policy Interpretation Training
  • Ability to obtain proper licensing / certifications as required
  • Assist Claims Representatives with in-person inspection/policyholder contact when needed
  • Assist Claims Assistant with scheduling, phone calls, company cars etc. as needed
  • May begin handling basic field Homeowners claims under close in person supervision
  • Willingness to do anything that will promote the business as a whole and to help it function as smoothly and efficiently as possible

  • Will be required to participate in catastrophe duty. Catastrophe (CAT) Duty will involve travel away from home for extended periods of time. CAT Duty requires travel to claims location which may be anywhere in US
    Preferred Qualifications:

  • Ability to stay organized and work though influxes in work load
  • Ability to learn and retain new concepts in both classroom and field settings
  • Excellent written and oral communication skills
  • Strong interpersonal, organizational and technological skills
  • Reliable, dependable and an exceptional work ethic
  • Proficiency with Microsoft Office applications
  • Proficient data entry skills / typing is also helpful
  • High-level initiative, follow-through & accountability for actions
  • Construction knowledge is helpful but not required
  • Possess good time management skills to be an efficient worker
  • Ability to change and evolve with the position as needed
  • Willingness to work irregular hours as needed during times of heavy claim activity
    Physical Requirements Ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car
  • Ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics
  • Ability to crouch and stoop to inspect confined attic spaces and go beneath homes into crawl spaces
  • Ability to work outdoors all year round, especially during summer months

    Job Type: Full-time

    Pay: $40,000.00 - $45,000.00 per year

    Benefits:
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance
    Schedule:
  • Monday to Friday
    Supplemental Pay:
  • Bonus pay

    Ability to commute/relocate:
  • Sun Lakes, AZ 85248: Reliably commute or planning to relocate before starting work (Required)

    Willingness to travel:
  • 50% Location: One location
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    Example 2

    Summary:Investigates, evaluates and determines compensability of claims, by performing the following duties.

    Essential Duties and Responsibilitiesinclude the following. Other duties may be assigned.

    Assigned duties of Claim Representative I.

    Performs investigative duties as required on a case by case basis.

    Reviews case law and resolves compensable medical only and non-litigated claims within the applicable laws and statutes.

    Estimates reserving for projected cost of claims through resolution, including indemnity benefits, permanency, medical treatments, etc.

    Makes referral to nurse case managers if additional medical support is required, and for surveillance when necessary.

    Directs claim assistants on duties to be performed for handling of claims.

    Negotiates settlement within designated authority.

    Competency:

    To perform the job successfully, an individual should demonstrate the following competencies:

    Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

    Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

    Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

    Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

    Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

    Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

    Quality- Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

    Adaptability

    Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays, or unexpected events.

    Teamwork

    Balances team and individual responsibilities; exhibits objectivity and openness to others’ views; gives and welcomes feedback; contributes to building a positive team spirit; puts success of team above own interests; able to build morale and group commitments to goals and objectives; supports everyone’s efforts to succeed; recognizes accomplishments of other team members.

    Analytical

    Synthesizes complex or diverse information; collects and researches data; uses intuition and experience to complement data; designs work flows and procedures.

    Written Communication

    Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.

    Motivation

    Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles; measures self against standard of excellence; takes calculated risks to accomplish goals.

    Qualifications:

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education/Experience:

    BS Degree or equivalent experience and one to three years of directly related experience.

    Language Ability:

    Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

    Reasoning Ability:

    Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

    Computer Skills:

    To perform this job successfully, an individual should have knowledge of Word Processing software and Spreadsheet software.

    Certificates and Licenses:

    (8) Hours of Continued Education on an annual basis.

    Physical Demands:

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Specific vision abilities required by this job include that the employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision. While performing the duties of this job, the employee is occasionally required to stand; walk and sit.

    Job Type: Full-time

    Benefits:
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Retirement plan
  • Vision insurance
    Physical Setting:
  • Office
    Schedule:
  • 8 hour shift
  • Monday to Friday

    Education:
  • Bachelor's (Preferred)

    Experience:
  • Worker's Compensation Claims: 1 year Location: One location
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    Example 3

    Summary

    Provides administrative support to the claims department as well as receives callers and directs them to the proper persons within the organization. Adept at working with and protecting confidential business information Analyzes health benefit claims to determine extent of PHC Participating Provider contractual discounts based on client plan design specifications. Reviews, evaluates online entry, error correction and / or final adjudication of paper/electronic claims. Follows organization policies and procedures to verify the validity of medical claims and determines whether to return or reprice claims based on coverage, diagnoses, and services that were provided.

    Essential Duties AND Responsibilitiesinclude the following.

    · Greets visitors, ascertains nature of business, and directs visitors to appropriate person(s).

    · Answers all initial telephone calls and provides requested information (including, but not limited to):

    o Claim status and discount questions

    o Provider participation requests for inclusion in the network

    o Assist clients, subscribers, and providers with inquiries and problem solving

    · Reads, date stamps, scans, and routes incoming mail and prepares outgoing mail.

    · Analyzes and organizes procedures such as flow of correspondence, requisition of supplies, and other services.

    · Maintain files – electronic & paper for clients/payors

    · Maintains Postage database for each department and supplies the Accounting Department with monthly report

    · Distributes and files internal correspondence and other records.

    · Composes correspondence and examines work for exactness, neatness, and conformance to policies and procedures.

    · Responsible for updating providers into claims systems.

    · Scan and archive all claims, communications and reports for the TPA Claims department

    · Handle insurance verification calls from providers while focusing on first call resolution.

    · Repricing of claims and all related processes

    · Import EDI claims and resolve errors in EDI batches.

    · Collates and distributes daily Benefit Statements to payors.

    · Meet claims productivity, quality assurance and turnaround time

    · Identify and return incomplete claims to proper party for additional information.

    · Be knowledgeable of all system codes and methodology as they relate to particular circumstances, clients, providers, etc. Keep updated on all plan changes, plan coverage & applicable ERISA and federally mandated laws.

    · Maintain and update the Policies & Procedures manual with step-by-step instructions as new procedures arise or current procedures change.

    · Perform claims customer service for all products, including inquiries on benefit coverage and claims status.

    · Communicate with insured’s, providers and business associates by telephone, email or written correspondence.

    · Other duties as assigned by the Vice President of Operations.

    Qualifications

    To perform this job successfully, the Claims Adjuster must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education and/or Experience

    Associate’s degree (A.A.) or equivalent from two – year College or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience. Knowledge of medical terminology and CPT/ICD- 9 code interpretation preferred.

    Language Skills

    Ability to read and interpret claims documents and procedure manuals.

    Mathematical Skills

    Ability to calculate figures and amounts such as discounts, interest, and percentages.

    Reasoning Ability

    Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, or scheduled form.

    Physical Demands

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    While performing the duties of this job, the employee is regularly required to sit. Specific vision abilities required by this job include close vision, and ability to adjust focus during computer operation.

    WORK Environment

    The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    The noise level in the work environment is usually quiet.

    Job Type: Full-time

    Pay: From $15.00 per hour

    Benefits:
  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance
    Physical Setting:
  • Office
    Schedule:
  • 8 hour shift

    COVID-19 considerations:
    PHC follows all CDC guidelines regarding Location: One location
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    Example 4

    Position Summary:

    Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves.

    Must be licensed in NY & HI or able to obtain within 30 days of hire.

    Duties & Responsibilities:
  • Exercises proper judgment and decision making to analyze the claims exposure, to determine the proper course of action and to appropriately settle the claim.
  • Interacts extensively with various parties involved in the claim process.
  • Able to clearly communicate concise action plans, and present plans for moving the case to conclusion.
  • Will demonstrate complete knowledge of the claim file process through presentation of actions and responses to client questions.
  • Processes claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements.
  • Demonstrated ability to comply with carrier reporting and threshold requirements

    Required:
  • 5 or more years related claims experience required
  • Appropriately licensed and/or certified in all states in which claims are being handled
  • Extensive knowledge of accepted industry standards and practices Computer experience with related claims and business software
  • Bachelor's Degree

  • Must have experience with Commercial Trucking.
  • Experience with bodily injury (BI) is desired.
    Work Traits:

  • Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges.
  • Analytical skill necessary to make decisions and resolve complex issues inherent in handling losses.
  • Ability to successfully negotiate the settlement and disposition of serious claims including the ability to interpret related documentation.

    Temporary to Permanent after 90 Days

    Potential for Remote

    Salary: Negotiable

    Job Type: Full-time

    Physical Setting:
  • Office
    Schedule:
  • 8 hour shift
  • Monday to Friday

    Education:
  • Bachelor's (Preferred)

    Experience:
  • Complex Liability Claims: 5 years (Required)

    License/Certification:
  • Adjuster License in NY,HI (Required)

    Willingness to travel:
  • 25% Location: One location
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    What Does a Claims Adjuster Do?

    Claims Adjusters typically work for insurance companies or insurance adjuster firms to help claimants receive the correct amount of funds in response to personal injury or property damage. They use their knowledge of their employer’s coverage options to apply claim criteria to the policyholder’s situation. Their job is to analyze the events surrounding property damage or personal injury to determine whether there’s a viable claim for compensation from the insurance company. 

    They may also need to maintain frequent communications with the claimant to update them on the claim process and when they can expect an answer about payment.

    Claims Adjuster Skills and Qualifications

    A Claims Adjuster interviews claimants and witnesses, inspects properties and completes additional research, including reviewing police reports when necessary. Skills and qualifications that assist in efficiently completing this job include: 

    • Analytical skills to evaluate if the insurance company is required to pay the claim. Claims Adjusters must consider multiple pieces of information to carefully make a decision. 
    • Communication skills to gather information from individuals, including medical experts, claimants and witnesses. They must know the correct questions to ask to get the information they need. 
    • Attention to detail to carefully review damaged property and documents.
    • Interpersonal skills to meet with claimants and other relevant individuals who may be upset by a situation. Claims Adjusters must be able to be understanding, yet firm with the company’s policies.
    • Math skills for calculating property damage.

    Claims Adjuster Salary Expectations 

    The average salary for a Claims Adjuster is $59,194 per year. This information is based on 2,375 anonymously submitted salaries along with information gathered from Indeed users and current and past job listings within the last 36 months. 

    Claims Adjuster Education and Training Requirements 

    While a high school diploma is a minimum requirement for an entry-level Claims Adjuster position, most employers look to hire individuals with a bachelor’s degree or other insurance-related work experience. In the beginning, Claims Adjusters work on smaller claims under the supervision of an experienced employee. As their knowledge grows about the claims process, including investigation and settlements, they are assigned more complex, larger claims. 

    Claims Adjuster Experience Requirements 

    Licensing requirements for a Claims Adjuster will vary from state to state. While some states have minimal requirements, others require either successful completion of pre-licensing education or a passing score on a licensing exam. Public Adjusters may be required to meet additional or separate requirements. Some states don’t require a Claims Adjuster to be individually licensed; instead, the Adjuster works under the company’s license. In some states that require licenses, Claims Adjusters must also complete a specific amount of continuing education credits each year to renew their licensure. 

    State and federal laws, along with court decisions, often affect what insurance policies are required to cover and how claims are handled. Claims Adjusters who work on health and life claims should stay up to date on the latest prescription drugs and new medical procedures. Adjusters who work with auto claims should be familiar with current repair techniques and new car models. To fulfill continuing education requirements, a Claims Adjuster can attend workshops or classes, write articles for claim publications or give presentations and lectures. 

    Job Description Samples for Similar Positions 

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    Frequently asked questions about Claims Adjusters

     

    What is the difference between a Claims Adjuster and a Claims Examiner?

    The difference between a Claims Adjuster and a Claims Examiner is that a Claims Examiner typically has more seniority than a Claims Adjuster and therefore has a different scope of responsibilities. For example, Claims Adjusters engage with policyholders, review damages and file claims to determine the payment a policyholder should receive for damages or injuries. 

    Once the Claims Adjuster files a claim, the Claims Examiner looks over the case and compares it to the Claim Adjuster’s suggested amount of payment. This helps them decide whether the policyholder should receive that amount from the insurance company.

     

    What are the daily duties of a Claims Adjuster?

    On a typical day, a Claims Adjuster starts by checking their email and phone messages. They reply to time-sensitive messages from coworkers or claimants and look over their to-do list to plan the schedule for the day. Throughout the day, they review insurance claims and contact claimants to schedule a meeting and learn more about the incident. They may also ask them to send pictures or connect them with emergency personnel to verify their claims. Claims Adjusters also travel to a claimant’s home to survey property damage in the event of a house fire or natural disaster. They take pictures at the scene to review once back in the office. 

    Once they compare the case to the insurance company’s payout policies they come up with a suggested sum to pay the claimant for repairs to damages or medical bill payments. They then file the claim and provide Claims Examiners with all the documents they need to confirm or deny the claim.

     

    What qualities make a good Claims Adjuster?

    A good Claims Adjuster is someone who seeks to find the best solutions for claimants while also adhering to the insurance company’s rules and guidelines surrounding insurance claims. They have an investigative mindset that enables them to seek out witnesses, police reports and other evidence to either support or disprove a claim. Further, a good Claims Adjuster has excellent interpersonal communication that allows them to adjust their communication to speak with insurance professionals, members of the public and claimants accordingly.

     

    Who does a Claims Adjuster report to?

    A Claims Adjuster typically reports to a Claims Manager within an Insurance company. They go to Claims Managers with questions regarding specific cases and to confirm what the insurance company covers in more unique cases.

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