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
  • Confer with legal counsel on claims when needed
  • Negotiate settlements
  • Authorize payments

What claims adjusters, appraisers, examiners, and investigators do varies by 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 to 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 to determine how much the insurance company should pay for the loss. The property they inspect could be a home, a business, or an automobile.

They interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. Adjusters 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.

They gather information—including photographs and statements, either written or recorded audio or video—and put it in a report that claims examiners use to evaluate the claim. When the examiner approves the policyholder’s claim, the claims adjuster negotiates with the claimant 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 self-employed 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.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

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 ensure that proper guidelines have been followed by claimants and adjusters. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. 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 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 claimants overstating 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 activities that would be ruled out by injuries stated in the claim.

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Work Environment

Claims adjusters, appraisers, examiners, and investigators held about 311,100 jobs in 2012. Their work environments vary. Claims adjusters and examiners spend time in offices reviewing documents and conducting research, in addition to working outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged buildings and automobiles 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 wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures.

The industries that employed the most claims adjusters, appraisers, examiners, and investigators in 2012 were as follows:

Insurance carriers 49%
Agencies, brokerages, and other insurance related activities 22
Federal government, excluding postal service 15
State and local government, excluding education and hospitals 4
Management of companies and enterprises 2

Work Schedules

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

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

In contrast, auto damage appraisers typically work regular hours and rarely work on the weekends, although they often spend much of their time at automotive body shops estimating vehicle damage costs.

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

Education and Training

A high school diploma or equivalent is typically required by employers who hire workers as entry-level claims adjusters, examiners, or investigators. Higher positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have a postsecondary non-degree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have a postsecondary non-degree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

Different backgrounds or college coursework are best for different types of work in these occupations. For example, a business or an accounting background might be best for someone to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the costs to repair damaged vehicles.

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

Training

At the beginning of their careers, 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 supervision of a more experienced appraiser while estimating damage costs until the employer decides the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements, and others require either completing pre-licensing education, a satisfactory score on a licensing exam, or both.

In some states, claims adjusters employed by insurance companies can work under the company license and need not become licensed themselves.

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 court decisions affect how 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 new car models and repair techniques. Workers can fulfill their continuing education requirements by attending classes or workshops, by writing articles for claims publications, or by giving lectures and presentations.

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 $59,960 in May 2012. The median wage is the wage at which half of the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $36,950, and the top 10 percent earned more than $89,810.

The median annual wage for insurance appraisers of auto damage was $58,610 in May 2012. The lowest 10 percent earned less than $42,260, and the top 10 percent earned more than $82,540.

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

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

In contrast, auto damage appraisers typically work regular hours and rarely work on the weekends, although they often spend much of their time at automotive body shops estimating vehicle damage costs.

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

Job Outlook

Employment of claims adjusters, appraisers, examiners, and investigators is projected to grow 3 percent from 2012 to 2022, slower than the average for all occupations.

Employment of claims adjusters, examiners, and investigators is projected to grow 4 percent from 2012 to 2022, slower than the average for all occupations. Employment growth should stem primarily from the growth of the health insurance industry. Federal legislation mandating individual coverage may increase the number of health insurance customers, including high-risk individuals who are more likely to file claims. This is expected to increase the demand for claims adjusters to determine which treatments are approved and how much the company will pay.

In addition, rising medical costs may result in a greater need for claims examiners to carefully review a growing number of medical claims. An increase in the number of claims being made by a growing elderly population should also spur demand for health insurance claims adjusters and examiners.

Demand for claims adjusters in property and casualty insurance is influenced by the number of natural disasters, such as floods and fires. According to data from the Federal Emergency Management Agency, the number of natural disasters has increased in recent years. If this trend continues, claims adjusters in this field may see strong employment growth.

These factors will be somewhat offset by automation. Technology allows less complex claims to be processed automatically, which frees adjusters to work on more complex claims. This means that fewer adjusters are needed per claim, reducing the needed number of adjusters on staff.

Employment of auto damage appraisers is projected to decline 5 percent from 2012 to 2022. In recent years, the number of automobile accidents relative to the population has declined. As automobiles become safer, the number of traffic accidents is expected to decline. This will result in decreased demand for the services of auto damage appraisers.                  

Job Prospects

Job opportunities for claims adjusters and examiners should be best in the health insurance industry as the number of health insurance customers expands. In addition, prospects for claims adjusters in property and casualty insurance will likely be best in areas susceptible to natural disasters. These areas include the Gulf Coast, which can have a large number of hurricanes, and the West Coast, which is vulnerable to wildfires.

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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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