Claims Adjusters, Examiners, and Investigators
In 2017, a devastating hurricane struck Houston, Texas, causing catastrophic flooding that led to billions of dollars in damage to residents' property. At the time, many homeowners affected by the storm didn't have flood insurance, which left them with huge financial burdens to rebuild their homes and replace their belongings. On the other hand, homeowners who had purchased flood insurance policies through an insurance company were able to receive financial compensation to help cover the cost of the damage. You've certainly read a lot of similar news stories before about institutions known as "insurance companies" covering certain damages that happen to people's property, whether their homes, cars, shops, or even health-related harm — but have you ever wondered exactly what insurance companies are? And why do they take on other people's burdens? The nature of insurance companies' work is that they offer to cover people's future accident-related losses, such as a house fire, a car crash, or damage to any other property, in exchange for customers paying a set monthly premium. These insurance companies deal with thousands of customers, and most of them will likely never experience any accidents at all — and that's what generates their profits. But what exactly happens when one of their customers does have an accident? How is the damage assessed, and how is the amount owed for that damage determined? To handle this, insurance companies hire experts known as "claims adjusters" to investigate accidents, assess damages, and estimate the compensation owed. They're also tasked with making sure the damage wasn't staged by the customer, but is instead the result of factors beyond their control.
Meet the Writer: Waleed Abo Omiraa
What You'll Actually Do
The core tasks and responsibilities that fill a typical day.
- 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.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- 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.
- Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Pay and process claims within designated authority level.
- Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- 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.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Collect evidence to support contested claims in court.
- Confer with legal counsel on claims requiring litigation.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Present cases and participate in their discussion at claim committee meetings.
- Report overpayments, underpayments, and other irregularities.
- Attend mediations or trials.