A claims adjuster is responsible for receiving, interpreting, and processing insurance claims in the event of an accident, emergency, or medical issue. The job description of a claims adjuster involves detailed knowledge of the insurance industry and an ability to comprehend a variety of different legalities within insurance policies.
A claims adjuster investigates accident sites and policyholder information, logs and processes insurance claims, and ultimately decides whether to deny or accept the claim.
Essential Duties and Responsibilities of a Claims Adjuster
•Receives and handles all incoming medical, automobile, or homeowner insurance claims.
•Reads and interprets reasons for claims.
•Conducts official interviews with claimants.
•Studies claimant’s policy to determine whether insurance will cover the incident.
•Investigates damages to automobiles and property as necessary.
•Requests and analyzes relevant police accident reports and hospital records.
•Follows up with all parties involved in accidents and emergencies to determine the nature of the event.
•Consults with legal and medical experts to gain further insight into the claim.
•Reviews all claims to check for any fraudulent or contradictory information.
•Logs all claim information.
•Maintains files on all policyholders and claim histories.
•Compiles all information to arrive at a final decision to accept or reject the insurance claim.
•Notifies claimant on the outcome of the claim.
•Addresses any complaints or queries from policyholders with regard to claims.
•Determines the cost to be covered by the insurance company.
•Draws up and processes paperwork related to the claim.
•Submits official claims to the insurance company.
Required Knowledge, Skills and Abilities
•Demonstrates specific knowledge of medical, automobile, or property insurance industry.
•Is capable of reading and interpreting dense insurance and legal documents.
•Can translate legal terminology into layman’s terms.
•Communicates clearly and effectively.
•Demonstrates strong organizational skills.
•Maintains professional and polite demeanor.
•Possesses basic computer skills for the purposes of data entry and record keeping.
•Is familiar with basic office equipment such as fax machines and multi-line phone systems.
•Exhibits excellent customer service skills and phone etiquette.
•Demonstrates solid analytical and interpretive abilities.
•Possesses strong negotiation skills.
•Pays close attention to detail.
•Exhibits excellent interpersonal and interviewing skills.
•Must be willing and able to travel locally for investigative purposes.
•Is capable of making confident and informed decisions independently.
Education and Experience
•High school or GED required.
•Associate’s Degree in related field strongly preferred.
•Work experience in the insurance sector required.
•Time will be spent in an office processing paperwork relevant to insurance claims.
•Time will also be spent traveling locally to interview policyholders and witnesses.
•Mild physical activity such as walking and standing will be involved on a daily basis.
•The average salary for a claims adjuster ranges from $40,000-$50,000 per year.
•The lowest-paid, entry-level adjusters make approximately $30,000 per year.
•The most experienced professionals can make up to $60,000 per year.