Claims Adjuster Job Description

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.

Position Description

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.

Work Environment

  • 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.

Salary

  • 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.

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