Claims Adjusters, Examiners, and Investigators


Also called : Claim Representative, Claims Adjuster, Claims Analyst, Claims Examiner, Claims Representative, Claims Specialist, Corporate Claims Examiner, General Adjuster, Home Office Claim Specialist, Litigation

What they do


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.

On the job, one would


  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

  • 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.

  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.

  • Collect evidence to support contested claims in court.

KNOWLEDGE


  • Customer and Personal Service
    Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

  • English Language
    Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

  • Law and Government
    Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

  • Administrative
    Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.

SKILLS


  • Critical Thinking
    Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

  • Reading Comprehension
    Understanding written sentences and paragraphs in work-related documents.

  • Active Listening
    Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

  • Speaking
    Talking to others to convey information effectively.

  • Negotiation
    Bringing others together and trying to reconcile differences.

ABILITIES


  • Oral Comprehension
    The ability to listen to and understand information and ideas presented through spoken words and sentences.

  • Written Comprehension
    The ability to read and understand information and ideas presented in writing.

  • Deductive Reasoning
    The ability to apply general rules to specific problems to produce answers that make sense.

  • Oral Expression
    The ability to communicate information and ideas in speaking so others will understand.

  • Inductive Reasoning
    The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).

PERSONALITY

People interested in this work, will do well at jobs that need;

  • Integrity
    Job requires being honest and ethical.

  • Dependability
    Job requires being reliable, responsible, and dependable, and fulfilling obligations.

  • Attention to Detail
    Job requires being careful about detail and thorough in completing work tasks.

  • Stress Tolerance
    Job requires accepting criticism and dealing calmly and effectively with high-stress situations.

  • Self-Control
    Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.

  • Independence
    Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.

  • Adaptability/Flexibility
    Job requires being open to change (positive or negative) and to considerable variety in the workplace.

  • Initiative
    Job requires a willingness to take on responsibilities and challenges.

  • Persistence
    Job requires persistence in the face of obstacles.

  • Achievement/Effort
    Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.

TECHNOLOGY

  • Access software

  • Analytical or scientific software

  • Computer aided design CAD software

  • Data base reporting software

  • Data base user interface and query software

  • Desktop publishing software

  • Document management software

  • Enterprise resource planning ERP software

  • Expert system software

  • Financial analysis software

  • Information retrieval or search software

EDUCATION AND TRAINING

  • Preparation

    Considerable Preparation Needed

  • Education

    Four-year bachelor degree

  • Experience

    A considerable amount of work-related skill, knowledge, or experience is needed for these occupation

  • Jobtraining

    Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.

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