Claim representatives, including both claim adjusters and claim examiners, investigate claims for insurance companies, negotiate settlements with policyholders, and authorize payment of claims.
Claim adjusters work for property-liability (casualty) insurance companies and usually specialize in specific types of claims such as fire, marine, or automobile. They determine whether their company is liable (that is, whether the customer's claim is a valid one covered by the customer's policy) and recommend the amount of settlement. In the course of investigating a claim, adjusters consider physical evidence, testimony of witnesses, and any applicable reports. They strive to protect their company from false or inflated claims and at the same time settle valid claims quickly and fairly. In some companies, adjusters submit their findings to claim examiners who review them and authorize payment.
In states with no-fault auto insurance, adjusters do not have to establish responsibility for a loss but must decide the amount of the loss. Many auto insurance companies employ special inside adjusters who settle smaller claims by mail or telephone or at special drive-in centers where claims are settled immediately.
Most claim adjusters work for insurance companies, but some work for independent firms that contract their services to insurance companies for a fee. These firms vary in size from local firms employing two or three adjusters to large national organizations with hundreds of adjustment specialists.
A few adjusters represent the insured rather than the insurance company. These public adjusters are retained by banks, financial organizations, and other businesses to negotiate settlements with insurance companies.
In life insurance companies, claim examiners are the equivalent of claim adjusters. In the course of settling a claim, an examiner might correspond with policyholders or their families, consult medical specialists, calculate benefit payments, and review claim applications for completeness. Questionable claims or those exceeding a specified amount would be even more thoroughly investigated by the examiner.
Claim examiners also maintain records of settled claims and prepare reports for company data processing departments. More experienced examiners serve on company committees, survey claim settlement procedures, and work to improve the efficiency of claim handling departments.
Related jobs are actuary, insurance agent and broker, and underwriter.
Places of employment and working conditions
Claim adjusters work in all sections of the United States, in cities and towns of all sizes. Claim examiners, on the other hand, work in home offices of insurance companies, most of which are located in and around Boston, Chicago, Dallas, New York City, Philadelphia, and San Francisco.
Adjusters make their own schedules, doing whatever is necessary to dispose of a claim promptly and fairly. Since most firms provide 24-hour claim service, adjusters are on call all the time and may work some weekends and evenings. They may be called to the site of an accident, fire, or burglary or the scene of a riot or hurricane. They must be physically fit since they spend much of their day traveling, climbing stairs, and actively investigating claims. Much of their time is spent out-of-doors-this is not a desk job.
Claim examiners, by contrast, do have desk jobs. Their usual workweek is 40 hours, but they may work longer hours during peak loads or when quarterly and annual reports are prepared. They may travel occasionally in the course of their investigations and are sometimes called upon to testify in court regarding contested claims.
Qualifications, education, and training
Claim representatives should be able to communicate tactfully and effectively. They need a good memory and should enjoy working with details. Some knowledge of computers is helpful because they are being used more and more for recordkeeping. Claim examiners must also be familiar with medical and legal terms, insurance laws and regulations, and have mathematical skills.
Insurance companies prefer to hire college graduates for positions as claim representatives but will sometimes hire those with specialized experience, for example, automobile repair experience for automobile claims adjuster positions. Because of the complexity of insurance regulations and claim procedures, however, claim representatives without a college degree may advance more slowly than those with two years or more of college.
Many large insurance companies provide on-the-job training combined with home-study courses for the newly hired claim adjusters and claim examiners. Throughout their careers, claim representatives continue to take a variety of courses and programs designed to certify them in many different areas of the profession.
Licensing of adjusters is required in most states. Requirements vary, but applicants usually must be 20 or 21 years of age and a resident of the state, complete an approved training course in insurance or loss adjusting, provide character references, pass a written examination, and file a surety bond (a bond guaranteeing performance of a contract or obligation).
Potential and advancement
About 144,000 persons are employed as claim representatives. While all indications point to continued growth of the insurance industry and a continued need for claim representatives, persons trying to enter the field will have an advantage if they have certain specialized skills. The growing trend toward drive-in claim centers and claim handling by telephone will probably reduce the demand for automobile adjusters but increase the demand for inside adjusters. Those who specialize in workers' compensation, product liability, and other types of complex business insurance will be more in demand than ever. Job opportunities for claim examiners are becoming more numerous in property-liability companies than in life insurance companies, where computers are processing more and more of the routine claims and group policy claims.
Claim representatives are promoted as they gain experience and complete courses and training programs. Those who demonstrate unusual ability or administrative skills may become department supervisors or may advance to management jobs. Some qualified adjusters, however, prefer to broaden their knowledge by transferring to other departments such as underwriting or sales.
Income
Earnings of claim representatives vary a great deal. Inside adjusters, those who contact claimants by telephone or mail to get information, earn an annual average salary between $22,300 and $26,700, depending on the level of their experience. Outside adjusters, workers who handle more complex cases and actually investigate claims, earn, on average, a yearly salary of between $24,800 and $33,200, depending on the level of their experience. Adjusters are often provided with a company car or reimbursed for using their own cars for business purposes.
Claim examiners earn an average yearly salary of between $33,600 and $47,100, depending on the level of their experience and responsibilities.
Additional sources of information
American Council of Life Insurance 1001, Washington, DC 20004
American Mutual Insurance Alliance, Chicago, IL 60606
Insurance Information Institute, New York, NY 10038
National Association of Independent Insurers Public Relations, Des Plaines, IL 60018
National Association of Public Adjusters, Baltimore, MD 21202
