Great Jobs KC

Claims Adjuster

What is it?

A claims adjuster acts as a mediator between an insurance company and its policyholders when a claim is filed. They investigate the details of the claim, assess the validity and extent of the loss, and work towards a fair and reasonable settlement for the policyholder. Here’s a breakdown of their key responsibilities:

Investigating Claims:

  • Gathering information: Upon receiving a claim, they gather information from the policyholder, including details of the incident, the extent of the damage or loss, and any relevant documentation (e.g., police reports, medical records, receipts).
  • Visiting the scene: In some cases, the adjuster might visit the scene of the incident (e.g., a car accident, property damage) to assess the situation firsthand and gather evidence like photographs or video recordings.
  • Interviewing witnesses: They may interview witnesses to the incident to gain different perspectives and corroborate the information provided by the policyholder.
  • Consulting with experts: Depending on the complexity of the claim, they might consult with experts like appraisers, contractors, or medical professionals to evaluate the value of damaged property or assess the validity of medical claims.

Evaluating the Claim:

  • Analyzing information: The adjuster carefully analyzes the gathered information, including reports, witness statements, and expert opinions, to determine the validity of the claim and the extent of the covered loss according to the policy terms and conditions.
  • Calculating the settlement amount: Based on their analysis, they calculate a fair and reasonable settlement amount that compensates the policyholder for the covered losses while adhering to the insurance company’s guidelines.
  • Negotiating with the policyholder: They negotiate with the policyholder to reach a mutually agreeable settlement amount, considering all the information gathered and adhering to company policies and regulations.
  • Denying claims: In cases where the claim is found to be invalid or not covered by the policy, the adjuster explains the reasons for denial to the policyholder in a clear and professional manner.
  • Managing the claims process: They ensure the claims process progresses smoothly, communicating effectively with the policyholder, keeping them informed about the status of their claim, and addressing any concerns they might have.
  • Maintaining accurate records: Throughout the process, the adjuster meticulously documents all communication, findings, and decisions made regarding the claim, ensuring accurate record-keeping for future reference.
  • Type of insurance: The specific tasks can differ slightly depending on the type of insurance they handle, such as auto insurance, property and casualty insurance, health insurance, or life insurance.
  • Work environment: They might work for the insurance company directly (employed adjusters) or be independent contractors hired by the insurance company to handle specific claims (independent adjusters).
  • Level of experience: Entry-level adjusters might start with handling simpler claims, while experienced professionals may handle complex cases, manage teams of adjusters, or specialize in specific areas like fraud investigation.

* Salary Range

$54,200 - $90,700

(entry level – experienced)

* Regional Jobs Available

465

(3 year forecast)

Length of Training

2 weeks

Type of Training

Hybrid

Is it Right For You?

Here are some essential skills and qualities for success as a claims adjuster:

  • Strong analytical and problem-solving skills: Effectively investigating claims, evaluating evidence, and making sound judgments require strong analytical and problem-solving abilities.
  • Excellent communication and interpersonal skills: Clearly communicating complex information to both technical and non-technical audiences, actively listening to policyholders’ concerns, and negotiating effectively are crucial.
  • Attention to detail and accuracy: Meticulous attention to detail is essential for accurately assessing claims, interpreting policy terms, and ensuring accurate record-keeping.
  • Composure and emotional intelligence: Claims adjusters often interact with individuals who are experiencing stressful situations, so composure, empathy, and emotional intelligence are crucial for navigating challenging situations respectfully and professionally.
  • Ability to work independently and as part of a team: While some tasks require independent investigation and analysis, collaboration with colleagues, experts, and supervisors is also important.

Overall, a career as a claims adjuster offers a dynamic and challenging path for individuals who possess strong analytical skills, enjoy problem-solving, and are dedicated to ensuring fair and efficient claim resolution within the insurance industry.

* Pay Range Data: Occupational Employment Wages Statistics (OEWS). 2023-Q3.
* Demand: Forecast data is based off national projections provided by the BoLS and adapted for regional growth patterns by Chmura.

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