Claims Adjusters, Examiners, and Investigators
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.
Sample of reported job titles:
Claim Representative, Claims Adjuster, Claims Analyst, Claims Examiner, Claims Representative, Claims Specialist, Corporate Claims Examiner, General Adjuster, Home Office Claim Specialist, Litigation Claim Representative
Occupation-Specific Information
Tasks
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Investigate and assess damage to property and create or review property damage estimates.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
Technology Skills
- Access software:CCC EZNet electronic communications network,CSC Automated Work Distributor AWD
- Analytical or scientific software:Injury Sciences EDR InSight,Insurance claims fraud detection software,Magnify Predictive Targeting System
- Computer aided design CAD software:4n6xprt Systems StiffCalcs,ARSoftware WinSMAC,CAD Zone Insurance,MapScenes Evidence Recorder,MapScenes Pro,PhotoModeler,Visual Statement Investigator Suite
- Data base reporting software:Corporate Systems ClaimsPro
- Data base user interface and query software:Claims processing administration and management software,Fair Isaac Claims Advisor,Tropics Claims Reserve Management
Occupational Requirements
Work Activities
- Working with Computers:Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
- Getting Information:Observing, receiving, and otherwise obtaining information from all relevant sources.
- Making Decisions and Solving Problems:Analyzing information and evaluating results to choose the best solution and solve problems.
- Communicating with Supervisors, Peers, or Subordinates:Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Resolving Conflicts and Negotiating with Others:Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
Detailed Work Activities
- Advise others on financial matters.
- Advise others on legal or regulatory compliance matters.
- Appraise property values.
- Calculate data to inform organizational operations.
- Collect evidence for legal proceedings.
Worker Requirements
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.
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.
- Mathematics:Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Worker Characteristics
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).
Interests
- Conventional:Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
- Enterprising:Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
- Investigative:Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.
Work Values
- Support:Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
- Independence:Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
- Working Conditions:Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
Work Styles
- 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.
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