Claims Adjuster, Appraiser, Examiner, or Investigator

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and if so, how much.

Duties

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants’ doctors or employers to get additional information on questionable claims
  • Talk with legal counsel about claims when needed
  • Negotiate settlements
  • Authorize payments

Claims adjusters, appraisers, examiners, and investigators have varying duties, depending on the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs so that they can properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable.

Adjusters inspect property damage or personal injury claims to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile.

Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. They may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

Adjusters gather information—including photographs and statements, either written or recorded on audio or video—and put together a report for claims examiners to review. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer’s position.

Some claims adjusters work as public adjusters. Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant. They are paid a percentage of the settled claim.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to make sure claimants and adjusters followed proper guidelines. They may help adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from overstated claims of vehicle damage to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does anything that would be suspicious based on injuries stated in the claim.

Work Environment

Claims adjusters, examiners, and investigators held about 314,300 jobs in 2021. The largest employers of claims adjusters, examiners, and investigators were as follows:

Direct insurance (except life, health, and medical) carriers 31%
Agencies, brokerages, and other insurance related activities      28
Federal government 15
Direct health and medical insurance carriers 9
State government, excluding education and hospitals 3

Insurance appraisers, auto damage held about 13,200 jobs in 2021. The largest employers of insurance appraisers, auto damage were as follows:

Insurance carriers 73%
Agencies, brokerages, and other insurance related activities       24
Self-employed workers 1

Claims adjusters and examiners work in offices when reviewing documents and conducting research. They work outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged automobiles and buildings and conducting surveillance. Auto damage appraisers spend much of their time at automotive body shops estimating vehicle damage costs.

Workers who inspect damaged buildings must be careful around potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Work Schedules

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules may vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.

Insurance investigators often work irregular schedules because of the need to contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

Education and Training

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator, although some positions require a bachelor’s degree or insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster or examiner. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Some insurance companies prefer to hire people trained as law enforcement officers or private investigators, because these workers have good interviewing and interrogation skills.

Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair. Many vocational schools and some community colleges offer programs in autobody repair that teach students how to estimate the cost of repairing damaged vehicles.

Training

Entry-level claims adjusters, examiners, and investigators work on small claims under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of an experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on their own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both). Jobseekers should verify the licensing laws with the state and locality in which they want to work. 

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and the outcomes of claim disputes adjudicated in court affect how the claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and prescription drugs. Examiners working on auto claims must be familiar with the most recent car models and repair techniques. To fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

The National Insurance Producer Registry (NIPR) provides information about state licensing requirements.

Personality and Interests

Claims adjusters, appraisers, examiners, and investigators typically have an interest in the Persuading and Organizing interest areas, according to the Holland Code framework. The Persuading interest area indicates a focus on influencing, motivating, and selling to other people. The Organizing interest area indicates a focus on working with information and processes to keep things arranged in orderly systems.

If you are not sure whether you have a Persuading or Organizing interest which might fit with a career as a claims adjuster, appraiser, examiner, and investigator, you can take a career test to measure your interests.

Claims adjusters, appraisers, examiners, and investigators should also possess the following specific qualities:

Analytical skills. Adjusters and examiners must evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

Pay

The median annual wage for claims adjusters, examiners, and investigators was $65,080 in May 2021. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $41,490, and the highest 10 percent earned more than $101,290.

The median annual wage for insurance appraisers, auto damage was $62,680 in May 2021. The lowest 10 percent earned less than $47,240, and the highest 10 percent earned more than $91,680.

In May 2021, the median annual wages for claims adjusters, examiners, and investigators in the top industries in which they worked were as follows:

Federal government $81,890
Direct insurance (except life, health, and medical) carriers 75,700
State government, excluding education and hospitals 63,970
Agencies, brokerages, and other insurance related activities      62,420
Direct health and medical insurance carriers 50,490

In May 2021, the median annual wages for insurance appraisers, auto damage in the top industries in which they worked were as follows:

Agencies, brokerages, and other insurance related activities      $63,960
Insurance carriers 62,610

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules may vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.

Insurance investigators often work irregular schedules because of the need to contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

Job Outlook

Overall employment of claims adjusters, appraisers, examiners, and investigators is projected to decline 6 percent from 2021 to 2031.

Despite declining employment, about 23,200 openings for claims adjusters, appraisers, examiners, and investigators are projected each year, on average, over the decade. All of those openings are expected to result from the need to replace workers who transfer to other occupations or exit the labor force, such as to retire. 

Employment

Technology is expected to automate some of the tasks that these workers currently perform. For example, computer software can evaluate photographs of damaged property and calculate an estimated claim amount. In addition, data collection and processing speed will continue to increase, which will improve efficiency and make workers more productive.

The number of natural disasters, such as floods and fires, influences demand for claims adjusters in property and casualty insurance. Future increases in the number of natural disasters could result in some employment growth for claims adjusters in the field.

For More Information

For more information about education and credentials for insurance-related occupations, visit

The Institutes

International Claim Association

National Association of Public Insurance Adjusters

For more information about state licensing requirements, check with your state insurance agency or visit

National Insurance Producer Registry (NIPR)

 

 

FAQ

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The career information above is taken from the Bureau of Labor Statistics Occupational Outlook Handbook. This excellent resource for occupational data is published by the U.S. Department of Labor every two years. Truity periodically updates our site with information from the BLS database.

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