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.