Occupation Details
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.
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Interests
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.
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.
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.
Work Values
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.
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.
Salary & Job Outlook
Starting Salary
$54,890.00
New York StateMedian Salary
$80,070.00
New York StateExperienced Salary
$96,020.00
New York StateNational Average for Comparison
New York State Job Market Outlook
Jobs Right Now (2018)
17,370
professionals in NYFuture Job Growth (2030)
16,920
+-45 jobs/yearNew Jobs Every Year
1,250
new opportunities yearlyGrowth Rate
0.0%
projected increasePreparation: Experience, Training, and Education
The list below outlines the prior educational experience required to perform in this occupation.
Degree Needed - Four-year college
Experience Requirements
A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
Education Requirements
Most of these occupations require a four-year bachelor's degree, but some do not.
Training Details
Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
Transferrable Skills and Experience
Many of these occupations involve coordinating, supervising, managing, or training others. Examples include real estate brokers, sales managers, database administrators, graphic designers, conservation scientists, art directors, and cost estimators.
School Programs
The following lists school programs which are applicable to this occupation.
Licensing & Certification
New York State requires workers in this occupation to hold a license or certification.
Insurance Adjuster, Independent
Learn MoreInsurance Adjuster, Public
Learn MoreApprenticeship
Contact your regional representative to learn more about apprenticeships available in your area by visiting Apprenticeship Contacts.
Skills
The list below includes the skills required by workers in this occupation; skills are what allow you to learn more quickly and improve your performance.
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.
Critical Thinking
Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
Speaking
Talking to others to convey information effectively.
Judgment and Decision Making
Considering the relative costs and benefits of potential actions to choose the most appropriate one.
Writing
Communicating effectively in writing as appropriate for the needs of the audience.
Skill level is measured on a seven point scale, where one means 'some competence required for this occupation' and seven means 'a high level of expertise required for this occupation'.
Knowledge
The list below includes knowledge items, the principles and facts required by this occupation.
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.
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.
Computers and Electronics
Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
Knowledge level is measured on a seven point scale, where one means 'some competence required for this occupation' and seven means 'a high level of expertise required for this occupation'.
Work Environment
The list below includes the physical and social factors that influence the nature of work in this occupation.
Hover over or tap each factor to see its description.
Work Styles
Included in the list below are the personal work style characteristics that can affect how well a worker is likely to perform in this occupation.
Achievement/Effort
Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
Adaptability/Flexibility
Job requires being open to change (positive or negative) and to considerable variety in the workplace.
Attention to Detail
Job requires being careful about detail and thorough in completing work tasks.
Cooperation
Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
Dependability
Job requires being reliable, responsible, and dependable, and fulfilling obligations.
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.
Initiative
Job requires a willingness to take on responsibilities and challenges.
Integrity
Job requires being honest and ethical.
Persistence
Job requires persistence in the face of obstacles.
Stress Tolerance
Job requires accepting criticism and dealing calmly and effectively with high-stress situations.
Tools & Technology
This list below describes the machines, equipment, tools, software, and information technology that workers in this occupation will use.
Tools
- Data collectors
- Desktop computers
- Event data recorders
- Handheld computers
- Measure markers
- Mobile wireless handheld communication devices
- Notebook computers
- Personal computers
- Personal digital assistants PDA
- Scanners
- Tablet computers
Technology
- 4n6xprt Systems StiffCalcs
- ADP software
- ARSoftware WinSMAC
- Automatic Data Processing Claims Manager & Dispatch
- Automatic Data Processing Estimating
- Axonwave Fraud and Abuse Management System
- BCCORP W5 for Adjusters
- Bill review software
- Brightwork Alyce Claims Systems
- CAD Zone Insurance
- CCC EZNet electronic communications network
- CCC GuidePost Decision Support
- CCC Pathways Appraisal Quality Solution
- CGI INSideOUT
- CGI-AMS BureauLink Enterprise
- CSC Automated Work Distributor AWD
Duties
Duties are job behaviors describing activities that occur on multiple jobs. The generalized and detailed work activities described in the list below apply to this occupation.
- recommend claim action
- recommend claim action
- direct and coordinate activities of workers or staff
- inspect property to determine damages
- inspect property
- develop management control systems
- maintain records, reports, or files
- maintain records, reports, or files
- prepare reports
- prepare reports
- fill out business or government forms
- write vehicle damage repair estimates
- fill out insurance forms
- estimate damage
- assess vehicle damage
- review data on insurance applications or policies
- review data on insurance applications or policies
- examine evidence to determine if it will support charges
- examine documents for completeness, accuracy, or conformance to standards
- follow contract, property, or insurance laws
- follow contract, property, or insurance laws
- use interviewing procedures
- use interviewing procedures
- use oral or written communication techniques
- follow rules of evidence procedures in legal setting
- use knowledge of investigation techniques
- use knowledge of investigation techniques
- use negotiation techniques
- calculate insurance premiums or awards
- compile information for court cases
- evaluate customer records
- investigate insurance claims
- investigate insurance claims
- verify investigative information
- verify investigative information
- compile evidence for court actions
- verify information for credit investigations
- note discrepancies in financial records
- analyze credit information gathered by investigation
- transcribe spoken or written information
- maintain insurance records
- maintain insurance records
- understand property documents
- determine liability
- make decisions
- assist with business or managerial research
- search legal records
- research property records
- gather physical evidence
- obtain information from individuals
- obtain information from individuals
- review insurance policies to determine appropriate coverage
- communicate technical information
- interview customers
- write business correspondence
- make presentations
- compile information through interviews
- compile information through interviews
- confer with prosecuting attorney
- use computers to enter, access or retrieve data
Tasks
The list below outlines specific tasks that a worker in this occupation is called upon to do regularly.
- Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
- Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- Pay and process claims within designated authority level.
- Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- 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.
- 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.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Confer with legal counsel on claims requiring litigation.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Collect evidence to support contested claims in court.
- Supervise claims adjusters to ensure that adjusters have followed proper methods.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Conduct detailed bill reviews to implement sound litigation management and expense control.
- Communicate with reinsurance brokers to obtain information necessary for processing claims.
- Present cases and participate in their discussion at claim committee meetings.
- Report overpayments, underpayments, and other irregularities.
- Attend mediations or trials.
- Examine titles to property to determine validity and act as company agent in transactions with property owners.
- Prepare reports to be submitted to company's data processing department.
- Obtain credit information from banks and other credit services.
Learning Resources
More information on this occupation may be found in the links provided below.
Claims adjusters, appraisers, examiners, and investigators
Visit this link for additional information on this career from the Occupational Outlook Handbook; a publication produced and maintained by the United States Department of Labor.
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