Nature of the Work:
Handling complaints, interpreting and explaining policies, resolving billing disputes, collecting delinquent accounts, and determining eligibility for governmental assistance are just a few examples of what adjusters, investigators, and collectors are expected to do.
Claim Representatives.
Claim representatives at insurance companies investigate claims, negotiate settlements, and authorize payments to claimants. When a policyholder files a claim for damage or a loss, the claim adjuster, claim examiner, or claim investigator must initially determine whether the customer's insurance policy covers it and the amount of the loss.
Minor claims filed by automobile or homeowner policyholders are usually handled by "inside adjusters" or "telephone adjusters." These workers contact claimants by telephone or by mail to get information on repair costs, medical expenses, or other details the company needs. Many companies centralize this operation in a drive-in claims center, where the cost of repair is determined and a check is issued immediately.
More complex cases are referred to an "independent adjuster" or "outside adjuster." Claim adjusters plan and schedule the work required to process a claim. They investigate claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability. They keep photographs, written or taped statements, or computer files of information obtained from witnesses and prepare reports of their findings. When the policy holder's claim is legitimate, the claim adjuster negotiates with the claimant and settles the claim. When claims are contested, adjusters may testify in court.
Some adjusters work with multiple lines of insurance. Others specialize in claims associated with fire damage, marine loss, automotive damage, product liability, or workers' compensation. Material damage adjusters inspect automobile damage and use the latest computerized estimating equipment to prepare estimates of the damage.
In life and health insurance companies, the counterpart of the claim adjuster is the claim examiner. In property and casualty insurance companies, the claim examiner may supervise claim adjusters. In both cases, they investigate questionable claims or authorize payment for those exceeding a designated amount. Larger claims are referred to senior examiners. Examiners may check claim applications for completeness and accuracy, interview medical specialists, consult policy files to verify information on a claim, or calculate benefit payments. They also maintain records of settled claims and prepare reports to be submitted to their company's data processing department.
Insurance Processing Clerks
Policy processing clerks process new insurance policies, modifications to existing policies, and claims. They begin the new policy process by reviewing the insurance application to ensure that all the questions have been answered. After an application has been reviewed by underwriters and the company determines that it will issue a policy, a policy processing clerk prepares the necessary forms and informs the insurance sales agent of an application's processing status. Policy processing clerks also update existing policies-such as a change in beneficiary, amount of coverage, or type of insurance- and recalculate premiums. They mail correspondence notices regarding changes to the sales agent and to the policyholder. Policy processing clerks maintain files for each policyholder, including policies that are to be reinstated or canceled.
Claim clerks, also called claim interviewers, obtain information from policyholders regarding claims. Claims may concern a number of things, such as fire damage, personal injury, or an automobile accident. They prepare reports and review insurance claim forms and related documents for completeness. They call or write the insured or other party involved for missing information and update claim files. They may transmit routine claims for payment or advise the claim supervisor if further investigation is needed.
Adjustment Clerks
Adjustment clerks investigate and resolve customers' complaints about merchandise, service, billing, or credit rating. They may work for banks, department stores, utility companies, and other large organizations selling products and services to the public. Sometimes they are called customer service representatives, customer complaint clerks, or adjustment correspondents.
Adjustment clerks examine all pertinent information to determine the validity of a customer's complaint. In a department store, this may mean checking sales slips or warranties, as well as the merchandise in question. In a bank, it could mean reviewing records and videotapes of automated teller machine transactions. In a utility company, they review meter books, microfilm, computer printouts, and machine accounting records. Regardless of the setting, these clerks get information-in person, by telephone, or through written correspondence-from all parties involved.
After an investigation and evaluation of the facts, adjustment clerks report their findings, adjustments, and recommendations. These may include exchanging merchandise, refunding money, crediting customers' accounts, or adjusting customers' bills. Adjustment clerks also ensure that the appropriate changes are set in motion and follow up on the recommendations to ensure customer satisfaction. To prevent similar complaints in the future, they may recommend to management improvements in product, packaging, shipping methods, service, or billing methods and procedures. Adjustment clerks keep records of all relevant matters, using them to prepare reports for their supervisors.
Adjustment clerks also respond to inquiries from customers. Clerks frequently can answer these inquiries with a form letter, but other times they must compose a letter themselves. Upon request, adjustment clerks issue duplicate or additional credit cards for banks and department stores.
Bill and Account Collectors
Bill and account collectors, sometimes called collection correspondents, are responsible for ensuring customers pay their overdue accounts. Some are employed by third party collection agencies, while others; known as "inside collectors," work directly for the original creditors, like department stores, hospitals, or banks.
Many companies automatically notify customers by mail if their account is overdue. When customers do not respond, collectors are called on to locate and notify them of the delinquent account, usually over the telephone, sometimes by letter. When customers move without leaving a forwarding address, collectors may check with the post office, telephone companies, credit bureaus, or former neighbors to obtain their new address. This is called "skip-tracing."
Once collectors find the debtor, they inform them of the overdue account and solicit payment. If necessary, they review the terms of the sale, service, or credit contract with the customer. Collectors may attempt to learn the cause of the delay in payment. Where feasible, they offer the customer advice and counsel on how to pay off the debts, such as by taking out a bill consolidation loan. However, the collector's objective is always to ensure that the customer first pays the debt in question.
If customers agree to pay, collectors note that for the record and check later to verify that the payment was indeed made. Collectors may have authority to grant an extension of time if customers ask for one. If customers fail to respond at all, collectors prepare a statement to that effect for the credit department of the establishment. In more extreme cases, collectors may initiate repossession proceedings or service disconnections, or hand the account over to an attorney for legal action.
Most collectors handle other administrative functions for the accounts assigned to them. This may include recording changes of addresses, and purging the records of the deceased. Bill and account collectors keep records of the amounts collected and the status of the accounts. Some fill out daily reports to keep their supervisors apprised of their progress. In some organizations, inside collectors receive payments and post the amounts to the customers' account. In most operations, however, the posting and receiving are done by other clerical workers. Collectors employed by collection agencies do not receive payments; rather, their primary responsibility is to get customers to pay their obligation.
Welfare Eligibility Workers and Interviewers
Welfare eligibility workers and interviewers-sometimes referred to as intake workers, eligibility determination workers, eligibility specialists, or income maintenance specialists-determine who can receive welfare and other types of social assistance. They do so by interviewing and investigating applicants and recipients to see who is eligible. Based on the personal and financial information they obtain and the rules and regulations of each program, they initiate procedures to grant, modify, deny, or terminate individuals' eligibility for various aid programs. This information is recorded and evaluated to determine the amounts of the grants.
Welfare eligibility workers and interviewers work with various public assistance programs. The best-known are Aid to Families with Dependent Children, Medicaid, Food Stamps, and the Work Incentive Program. Depending on local circumstances, there may be other programs, such as those for public housing, refugee assistance, and fuel assistance.
Most welfare eligibility workers and interviewers specialize in a specific area, such as housing, but some are responsible for several areas. They may assist social workers by informing them of pertinent information they have gathered during their interviews with applicants. In some areas, particularly rural ones, eligibility workers may also perform other welfare duties.
These workers often provide information to applicants and current recipients. For example, they may explain and interpret eligibility rules and regulations or identify other resources available in the community for financial or social welfare assistance. More experienced workers may help train new workers. In addition, they may be assigned to special units whose responsibility is to detect fraud.
Although these workers usually interview applicants and recipients who visit their offices, they may make occasional home visits, especially if the applicant or recipient is elderly or disabled. They may also check with employers or other references to verify answers and get further information.
The authority of welfare eligibility workers and interviewers varies from one jurisdiction to another. In some places, these workers are authorized to decide on an applicant's eligibility, subject to review by their supervisor. In other places, however, they can only make recommendations to their supervisors, who in turn make the ultimate decision.
Working Conditions
Most claim examiners have desk jobs that require no unusual physical activity. They typically work a standard five-day, 40-hour week. Claim examiners may work longer hours during peak periods or when quarterly and annual statements are prepared. Sometimes they travel from time to time to obtain information by personal interview.
Many claim adjusters work outside the office, visiting and inspecting damaged buildings, for example. Occasionally, experienced adjusters are away from home for days when they travel to the scene of a disaster-such as a tornado, hurricane, or flood- or work with local adjusters and government officials. Some adjusters are on "emergency call" in the case of such incidents. Material damage adjusters work at local claim centers where policy holders take their cars for estimates of damage.
Adjusters generally have the flexibility to arrange their work schedule to accommodate evening and weekend appointments with clients. Some report to the office every morning to get their assignments while others simply call from home and spend their lays traveling to claim sites. This enables some adjusters to work independently.
Most insurance processing clerks work 40 hours a week. Much of the work is routine and requires remaining at work stations for extended periods of time. Because most insurance information is stored on computers, many of these workers; it at video display terminals and enter or access information while he customer is on the phone. Because most companies provide 4-hour claim service to their policyholders, some claim clerks work evenings and weekends. Many claim clerks work part-time.
Adjustment clerks, bill and account collectors, and welfare eligibility workers and interviewers work in offices, usually during regular business hours. Some work part-time. A few bill and account collectors work as temporaries. From their offices, they deal with customers, clients, or applicants, either by telephone or in person. Dealing with upset or angry clients is often part of the daily routine in these jobs, making the work stressful at times.
Some welfare eligibility workers and interviewers may be hired on a seasonal basis to help administer a specific program. For example, some states hire these workers for the winter to help run emergency fuel assistance programs.
Training, Other Qualifications, and Advancement
Training and entry requirements vary widely for adjuster, investigator, and collector jobs. A high school education is sufficient to qualify for most insurance processing clerk, adjustment clerk, and bill and account collector positions, while a bachelor's degree is preferred for most claim representative positions. While some college education is preferred for positions as adjuster or welfare eligibility worker or interviewer, many people qualify for these positions on the strength of related prior work experience. Because a significant and growing proportion of adjusters, investigators, and collectors use computers, courses in typing or word processing are recommended. Employers increasingly view experience with computers as an asset.
Claim Representatives
Most companies prefer to hire college graduates for claim representative positions. Entry-level workers may be hired without college coursework if they have specialized experience. For example, people with knowledge of automobile mechanics or body repair may qualify as material damage adjusters and those with extensive clerical experience might be hired as inside adjusters. Both adjusters and examiners should be observant and enjoy working with details.
No specific college major is recommended as the best preparation for these occupations. Although courses in insurance, economics or other business subjects are helpful, a degree in almost any field is adequate. An adjuster who has a business or an accounting background might specialize in claims of financial loss due to strikes, breakdowns in equipment, or damage to merchandise. College training in engineering is helpful in adjusting industrial claims, such as damage from fires and other accidents. A legal background is most helpful to those handling workers' compensation and product liability cases. Knowledge of computer applications is increasingly important, and in most instances essential.
Most states require adjusters to be licensed. Applicants usually must comply with one or more of the following: Pass a written examination covering the fundamentals of adjusting; complete an approved course in insurance or loss adjusting; furnish character references; be at least 20 or 21 years of age and a resident of the state; and file a surety bond.
Because they often work closely with claimants, witnesses, and other insurance professionals, claim representatives must be able to communicate effectively with others. Some companies require applicants to pass a battery of written aptitude tests designed to measure communication, analytical, and general mathematical skills. Examiners must understand federal and state insurance laws and regulations.
Workers may receive their training through courses offered by the Insurance Institute of America, a nonprofit organization offering educational programs and professional certification to persons in the property-liability insurance industry. The Insurance Institute of America offers an Associate in Claims designation upon successful completion of four essay examinations. Adjusters can prepare for the examination by independent home study or through company or public classes.
The International Claim Association offers a program on life and health insurance claim administration. Completion of the six-examination program leads to the professional designation, Associate, Life and Health Claims.
Beginning adjusters and examiners work on small claims under the supervision of an experienced worker. As they learn more about claim investigation and settlement, they are assigned larger, more complex claims. Trainees are promoted as they demonstrate competence in handling assignments and as they progress in their course work. Because of the complexity of insurance regulations and claim procedures, workers who lack formal academic training tend to advance slower than those with additional education. Employees who demonstrate competence in claim work or administrative skills may be promoted to department supervisor in a field office or to a managerial position in the home office.
Insurance Processing Clerks
High school graduation is considered adequate preparation for most insurance processing clerk positions. Courses in typing and word processing, and business arithmetic are desirable. Employers view favorably previous office experience and familiarity with computers. Most new workers begin as file clerks and move into insurance processing positions as they demonstrate their ability. However, people with considerable clerical experience may begin processing insurance policies immediately.
Some experienced insurance processing clerks may be promoted to a clerical supervisor position. Advancement to a claim representative or an underwriting technician position is possible for clerks who demonstrate potential, have college coursework, or have taken specialized courses in insurance. Many companies offer home-study courses for their employees so they can acquire the knowledge necessary to advance.
Adjustment Clerks
Many employers do not require an; formal education for adjustment clerk positions. Instead, they look for people who can read and write and who possess good communications and interpersonal skills. Typing ability is also viewed favorably.
Adjustment clerk is an entry-level position in some, but not all, organizations. Depending on their assignment, new adjustment clerks may receive training on the job from a supervisor an experienced coworker, or they may enter a formal training course offered by the organization. Training covers such topics a how to use computers, what standard forms to use, whom to con tact in other departments of the organization, and how to deal with customers. Some employers provide more advanced training for experienced adjustment clerks. This training may be offered in-house or from trade associations or local colleges.
Bill and Account Collectors
While high school graduation sometimes is required by employers, formal education beyond high school is not stressed. Previous work experience as a collector is particularly valuable. Experience in the field of telemarketing or as a tele phone operator also is helpful, as is knowledge of the billing process. Employers seek individuals who speak well and who are persistent and detail-oriented.
Employers normally provide training to new bill and account collectors. This training, which may last up to a couple of months, is usually conducted in a classroom or on the job. It may use lectures, videotapes, computer programs, role-playing, and hands-on experience. In addition to learning about the firm's billing procedure, new collectors learn communications and negotiating skills. Successful bill and account collectors may become supervisors. Some even start their own collection agencies.
Welfare Eligibility Workers and Interviewers
Hiring requirements for welfare eligibility workers and interviewers vary widely. Depending on the jurisdiction, applicants may need a high school diploma, some postsecondary training, or a bachelor's degree. Previous work experience may be substituted for education in some places, particularly if it is in a closely related field like employment interviewing, social work, or insurance claims. Fluency in a foreign language may be an advantage in parts of the country with a high concentration of non-English speaking people.
Because they deal with people who are in difficult economic circumstances, welfare eligibility workers and interviewers should be compassionate and empathetic. Attention to detail is important because there are many procedures, and regulations that must be observed.
After they are hired, eligibility workers arc given training, sometimes in a formal classroom setting, other times in a more informal manner. They are taught the policies, procedures, and program regulations that they are expected to use to determine eligibility. If a formal training program is selected, it generally is followed by on-the-job training provided by the supervisor. Advancement to the job of social worker is possible, although additional formal education such as a bachelor's or master's degree usually is needed.
Job Outlook
Overall employment of adjusters, investigators, and collectors is expected to grow faster than the average for all occupations throughout the year. Most job openings will result from the need to replace workers who transfer to other occupations or leave the labor force.
Growth rates will vary considerably by occupation. Employment of insurance claim examiners is expected to grow about is fast as the average as the increasing volume of insurance results in more insurance claims. Shifts in the age distribution of the population will result in a large increase in the number of people who assume career and family responsibilities. People in this group have the greatest need for life and health insurance, as well as protection for homes, automobiles, and other possessions.
A growing demand for insurance coverage for working women is also expected. New or expanding businesses will need protection for new plants and equipment and for insurance covering their employees' health and safety. Opportunities should be particularly good for claim representatives who specialize in complex business insurance such as marine cargo, workers' compensation and pollution liability.
Employment of insurance processing clerks is expected to grow more slowly than the average as computerization automates some functions performed by these workers, although the increasing number of policyholders will require more workers to provide customer service. Within this group, employment of adjusters and claim clerks will increase about as fast as the average because their work requires much interpersonal contact, which cannot be automated. However, employment of policy processing clerks will decline because their jobs can be automated. The number of job openings for workers in the insurance industry should not fluctuate greatly from year to year. This industry, particularly the health insurance component, is less sensitive to cyclical swings in the economy than most industries.
Employment of adjustment clerks is expected to grow much faster than the average as business establishments place an increased emphasis on maintaining good customer relations. An important aspect of good customer service is resolving customers' complaints in a friendly and timely fashion. Because much of their work involves direct communication with customers, demand for adjustment clerks is expected to keep pace with the growth in the number of customers.
Bill and account collector jobs also are expected to grow much faster than average as the level of consumer debt rises. As the economy expands, firms will strive to increase the efficiency of their debt collection to keep losses at a minimum. Contrary to the pattern in most occupations, employment of bill and account collectors tends to rise during recessions. This is due primarily to the difficulty that many individuals have in meeting their financial obligations.
Employment of welfare eligibility workers and interviewers is expected to grow more slowly than average as state and local governments attempt to curb the growth in their expenditures for public assistance.
Related Occupations
Insurance adjusters and examiners investigate, analyze, and determine the validity of their firm's liability concerning personal, casualty, or property loss or damages and effect settlement with claimants. Workers in other occupations that require similar skills include cost estimators, budget analysts, and private investigators.
The work of insurance processing clerks and adjustment clerks is similar to that of other workers who compile, review, or maintain records, including coding, contract, auditing, and reservation clerks and title searchers.
The work of bill and account collectors is related to that of customer service representatives, telemarketers, telephone interviewers, and other workers who deal with the public over the telephone.
The work of welfare eligibility workers is similar to that of human services workers, financial aid counselors, loan counselors, credit counselors, probation officers, and other workers who interview customers or clients.
