Claims adjusters, appraisers, examiners, and investigators are insurance-field professionals who evaluate and process policyholders’ claims of property damage, liability, or bodily injury. Most workers are employed by property and liability insurance companies, reviewing and negotiating individual and business claims in a manner that complies with federal law. Though these four job descriptions may share some responsibilities, insurance companies often separate positions according to the stages of the claim process.
Claims adjusters are the liaison between the insurance company that employs them and the policyholder. When a policyholder makes a claim, the claims adjuster will develop a plan of action, visit accident or damage sites to interview those involved, request medical records, gather information (i.e., photos, videos, and attestations), determine what should be paid for the loss, file the claim, and negotiate a payout if it is approved. In addition, claims adjusters may defend the claim in court if it is contested.
Some claims adjusters work as independent public contractors hired by claimants who prefer not to use the services of insurance company adjusters. Freelance adjusters are also sometimes hired by insurance companies to contract out work. Essentially, the claims adjuster works to negotiate the best payout according to the interests of their employer, whether that is the claimant or the insurance provider.
Claims appraisers focus on evaluating the monetary value of damaged, insured property, such as motor vehicles or homes. Appraisers inspect the items, determine the value of the loss, and submit that information to adjusters to include in the overall claim.
Claims examiners scrutinize the accuracy of filed claims, particular in the medical field. They verify information, compare industry averages for care against what a claimant received, approve or deny the claim based on insurance company policy, and send the claim to an investigator for additional action if needed. Examiners also review death benefit claims and life insurance applications.
If adjusters, appraisers, or examiners have reason to believe that a claim is fraudulent, they will refer it to an investigator. Insurance investigators handle instances of suspected arson, faked accidents, inflated claims, criminal activities, or unnecessary medical services. Investigators mine databases for information, interview individuals involved, conduct surveillance, and build a case against any false claims.
These professionals work in varying environments and conditions, depending upon their specific jobs. Some divide their time between processing claims in an office setting and traveling to conduct interviews and investigations, some spend most of their time out of doors, while others spend the majority of time working at a desk or workstation. Work hours also vary according to position and demand for services.
Education, Training, and Essential Skills
There are no state or federally mandated educational requirements for these jobs, though some states require such workers to be licensed and/or bonded. While some insurance companies prefer these employees to have a college degree, it is entirely up to the discretion of the employer. A high school diploma or equivalency is generally the minimum educational level employers look for, combined with sufficient insurance-field work experience.
College, vocational, or continuing education coursework relevant to this field is highly dependent on the particular job desired. A prospective automotive adjuster or assessor would benefit from classes on automotive repair. For jobs in industrial claims, engineering or architecture courses are appropriate. In health insurance positions, some medical training or background is useful, while insurance investigators are generally law enforcement officers or private investigators.
Because background, training, and educational skills are so variable for these positions, employers generally provide new hires with on-the-job training, assigning them to work with more seasoned supervisors on smaller claims until they gain skills and experience.
Strong interpersonal, communication, computing, analytical, and mathematical skills, as well as a deep sense of ethics and integrity, are a must for these positions.
Advancement and Professional Development Opportunities
Professional development and advancement are inextricably linked for these jobs, as workers must stay up-to-date on changes in insurance regulation, legislation, medical advances, and automotive industry innovations. In those states that require licensure or bonding, a certain number of continuing education credits is required per year to keep the license current. Professional associations also offer industry-recognized certifications and designations that require a combination of experience and knowledge.
Advancement for these positions is generally achieved through promotion from subordinate jobs to those with increasing levels of responsibility. Additionally, seasoned professionals may go to work as independent contractors, allowing them better control over their own workload and income.
Outlook and Income
Job opportunities for claims adjusters, appraisers, examiners, and investigators are projected to increase by 7% over the next decade, with highest demand in the healthcare field.
The median annual salary for these professionals is about $56,000, with the highest median at $73,000 and the lowest at $36,000. Some professionals also enjoy additional perquisites like a laptop computer, smart phone, and company vehicle.