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Claims Adjuster, Appraiser and Investigator Career, Job and Employment Information


The following are just a few claims adjuster and appraiser career and job highlights:

  • Investigating insurance claims, negotiating settlements, and authorizing payments, investigators deal with claims where there is a question of liability and where fraud or criminal activity is suspected.
  • A college degree is preferred by most employees.
  • Because this occupation attracts many qualified people, competition will be strong for jobs as investigators.

Claims Adjuster, Appraiser and Investigator Career Overview

Insurance policies are purchased by both individuals as well as businesses in order to safeguard their financial assets. Should such a loss occur, the policyholder must submit a claim or request for payment to the insurance company in order to be compensated for their loss. Primarily employed by property and casualty insurance companies, adjusters, examiners, and investigators handle a broad assortment of claims including those relating to property damage, bodily injury and liability. Their main objective is to investigate the claims, negotiate settlements, and authorize payments to claimants. However, they must always take care not to breach Federal and State privacy laws and violate the claimant’s rights. It is the responsibility of such adjusters, examiners, and investigators to determine whether or not the customer’s insurance policy covers their damages and if so, how much of the loss should be paid to the claimant. Generally, the insurance industry assigns specific roles to each of these claims workers, nevertheless many may have overlapping functions or may even carry out the same job.

Adjusters are responsible to plan and schedule the work required to process a claim. For example, lets say that an automobile accident or damage to one’s home was caused by a storm. The claim workers would then investigate the claim by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company’s liability. Other professionals, such as accountants, architects, construction workers, lawyers, engineers, and physicians, who can offer a more expert evaluation of a claim, may also be consulted by the adjuster. A report is then created with the information gathered. Such information may include written or taped statements as well as photographs, all vital to the final evaluation of the claim. If the policyholder’s claim is found to be legitimate, the claims adjuster negotiates with the claimant and settles the claim. When claims are questionable or disputed, adjusters will work with expert witnesses and attorneys to defend the insurer’s position.

For many companies the claims-adjusting operation is much less taxing. Often claims are brought in and centralized in a claims center. Here the cost of repair is determined by various adjusters and a check is immediately issued to the claimant. In situations where more complex cases arise such as those involving bodily injury, the claim is referred to a senior adjuster for review. Although some adjusters work with multiples types of insurance, most specialize in one particular type. Types of insurance range from homeowner’s claims or business losses, to automotive damage or workers compensation.

Some claimants may choose not to rely on the services provided by their insurance company’s adjuster. Instead they may decide to hire a public adjuster. Public adjusters work for the claimant assisting them in preparing and presenting their claims to their insurance companies. It is their purpose to try and negotiate a fair settlement for their client. All in all public adjusters perform the same services as the insurance adjusters, except that they work in the best interest of their client rather than the insurance company.

Claims examiners working within casualty and property insurance firms may have quite a few responsibilities similar to those of an adjuster. However, their principal duty is to review the submitted claims ensuring that proper guidelines and procedures have been followed. When a disaster suddenly swells the volume of claims, they may also be asked to help and support adjusters with complex and complicated claims. The vast majority of claims examiners work for health or life insurance agencies, and usually specialize in a specific group of individual insurance plan. They may also specialize in hospital, dental, or prescription drug claims. In such cases examiners are responsible for the evaluation of health-related claims. They review the claim using a large supply of information which enlightens them as to the expected treatments a claimant may receive, average length of hospital stays, and the average period of disability for specific injuries. The claims examiners are then able to decide whether the costs claimed by the claimant are reasonable given the diagnosis. Examiners are also responsible for checking claim applications for accuracy, and completeness. They may be asked to interview medical specialists, or to consult policy files to substantiate the information reported in a claim. Once accuracy and completeness are assured and the costs determined reasonable the examiner will authorize the appropriate payment to the claimant. In such cases where accuracy, completeness, or cost is in question the examiner may refer the claim to an investigator for a more detailed review.

The main responsibility of examiners reviewing claims for life insurance is to evaluate the cause of death. This is especially important in cases involving an accident because most life insurance policies give out additional benefits if a death is determined accidental. Claim examiners may also review applications for new policy holders. Before an applicant can be accepted the examiner must make sure that applicants have no serious illnesses that would make them a high risk to insure. Most high risk applicants are disqualified from obtaining insurance.

The appraiser plays another essential role in the accurate settlement of claims. Appraisers assess the cost or value of an insured item by inspecting the damage done to a particular item such as a vehicle after an accident. They are then responsible to approximate the cost of repairs and to relay that information to the adjuster. The adjuster will them incorporate that information into the settlement. Most appraisers employed by independent adjusting firms and insurance companies are auto damage appraisers. Because they can provide an impartial judgment of repair costs, auto damage appraisers are highly valued by insurance companies. Without an appraiser the companies would have to rely solely on auto mechanic estimates, which are often unreasonably high.

Modern technology is enormously valuable to many claims adjusters. Laptops are used to download forms and files from insurance company databases, and digital cameras permit photographs of damaged items and property to be sent to the company through the Internet. Many claims adjusters also use their computers to directly input information detailing damages and have software programs that are able to produce immediate estimates of damage on standard forms. Each of these new technologies allow processing claims to be faster and more efficient.

An Insurance Investigator is called in when adjusters or examiners suspect a scam. Cases of suspected fraudulent or criminal activity such as arson, false disability claims, staged accidents, or unnecessary medical treatments are all investigated by insurance investigators in an insurance company’s Special Investigative Unit. The gravity of insurance fraud cases can vary substantially. Some claimants simply overstate the damage done on their vehicle hoping to get more money, while other scams are conjured up through complicated fraud rings supported by dishonest doctors, lawyers, and even other insurance personnel.

Investigation of each new case usually starts with a database search used to obtain background information on claimants and witnesses. This search gives investigators access to a plethora of information including driver’s license numbers, accurate identification of Social Security numbers, addresses, aliases, phone numbers, criminal records, and past claims histories. This information may become useful in helping an investigator ascertain the legitimacy of a claimants claim. After the initial search investigators may then visit claimants and witnesses to obtain a recorded statement, inspect facilities, such as a doctor’s office and determine whether or not they have a proper license. They may also take pictures of damage of perform surveillance work. For example, in a case involving fraudulent workers’ compensation claims, an investigator may surreptitiously observe the claimant for several days or even weeks. If the investigator sees the subject carrying out an activity that is deemed off limits or unachievable due to specific injuries stated in a workers’ compensation claim, the investigator may take record video or take still photographs to document the activity and report it to the insurance company. Investigators may also talk with and consult a legal counsel who may act as an expert witness in cases that make it to court.

Job Training and Qualifications

The training and entry requirement specified by employers for claims adjusters, examiners, appraisers, and investigators vary significantly. Many of these occupations do not coincide with a specific college degree. However, most companies still prefer to hire college graduates. Although no specific major is required or even recommended, there are a variety of courses which can become assets to those interested in working in this particular field. For example, a background in business or accounting might be helpful to a claims adjuster specializing in claims of financial loss due to equipment breakdowns, damage to merchandise or strike; while an adjuster focusing on industrial claims such as those involving damage from fires or other accidents may find a background in architecture or engineering to be useful. Specialized expertise acquired through professional training given on the job may also be used to adjust claims. And for some, a legal background can be beneficial when handling claims dealing with product liability or workers’ compensation. For examiners working on medical and life insurance claims a background in medicine may prove useful.

Effective communication is a vital skill that all claims adjuster and examiners must possess. Because they often work closely with claimants, witnesses, and other insurance professionals clear exchange of ideas and mutual understanding is crucial. A knowledge and familiarity of computer applications is also tremendously important. Other requirements may include a valid drivers license and good driving record, and perhaps a written exam testing an applicants analytical, mathematical, and communicative skills.

Claims adjusters, examiners, appraisers, and investigators should become licensed. Requirements for licensing vary from State to State. Some states have very few requirements, while others require the completion of a pre-licensing education course or a satisfactory score on a licensing exam. In some cases completion of the requirements needed to earn a voluntary professional designation may be substituted for the exam. In some States, claims adjusters employed by licensed insurance companies can work under the company license and do not need to become licensed themselves. Separate or additional requirements may apply for public adjusters. For example, some States require public adjusters to file a surety bond.

Because Federal and State laws are continually being added and revised, continuing career education classes in claims is very important for claims adjusters, examiners, appraisers, and investigators. Updated knowledge will help assure effectiveness in handling claims and in presenting court cases. Continually education is also important for examiners working on health and life insurance claims as they must be familiar with new medical procedures and prescription drugs. Of the states that require licensing a great many also require that a certain number of continuing education credits be earned each year in order to renew the license. These credits are obtainable through a number of sources. Many are offered through insurance companies by way of seminars or special training. Others are available through correspondence or by writing journal articles for claims publications, and by giving lectures or presentations. In addition, many adjusters and examiners choose to earn professional certifications and designations for independent recognition of their professional expertise. The requirements for these designations vary, but many can necessitate at least 5 to 10 years’ experience in the claims field as well as the passing examinations and continued earning of a certain number of CE credits each year to retain the designation.

Persons with experience as an estimator or manager of an auto-body repair shop will be especially qualified for jobs as an auto damage appraiser. Insurance companies as well as independent adjusting firms prefer to hire persons with such experience because an appraiser must know how to repair vehicles in order to identify and estimate damages. Technical skills are also vital to this position. In most cases auto damage appraisers do not require a college ducation, however formal training is always a plus. Some candidates may choose to attend a vocational colleges offering a 2-year program in auto-body repair and how to estimate and repair damaged vehicles. In some states auto damage appraisers may also be required to meet licensing standards. Certification may also be required or preferred. Familiarity and understanding of basic computer skills is also important. As with adjusters and examiners, continuing education is valuable because of the continual introduction of new car models and repair techniques.

Because of the experience they carry with them, a large majority of insurance companies prefer to hire former private investigators or law enforcement of officers as insurance investigators. Experienced claims adjusters or examiners may also qualify to become investigators. Persistence, ingenuity, and assertiveness are all qualities sought after by employers. It is important that investigators not be afraid of confrontation. They must also be able to communicate well, and be able to think on their feet. Often acquired in previous law enforcement careers, good interviewing and interrogation skills are also valuable. State requirements necessary for licensing vary by the individual State.

In the beginning, claims adjusters, appraisers, examiners, and investigators work on small claims assignments under the direct supervision of an experienced worker. Overtime new employees become confident in their duties. They continue to learn more about claims investigation and settlements, and are eventually assigned to larger, more complex claims. Claims adjusters, appraisers, examiners, and investigators who begin their career as trainees are promoted as they progress in their coursework and demonstrate competence in handling various assignments. Employees who exhibit proficiency in claims work or administrative skills may find themselves being promoted to more responsible managerial or administrative jobs. Claims investigators may also rise to supervisor or manager positions within the investigations department. After achieving a certain level of expertise, many such workers go on to start their own independent adjusting or auto damage appraising firms.

Job and Employment Opportunities

The growth rate for employment of claims adjusters, examiners, appraisers, and investigators through the year 2012 is expected to grow approximately as fast as the average for all other occupations. For those who have earned a college degree, opportunities for employment will be more plentiful. In addition to growth expansion, it is expected that numerous job openings will come about in order to replace employees who either transfer to another occupation or retire from the work force.

In an effort to contain costs, many insurance companies are downsizing their claims departments. Larger companies are allowing adjusters to spend more time investigating claims and turning other faucets over to customer service call center representatives. New technology is also having an affect on such positions. Computer programs assist adjusters in completing claims at a much quicker rate which increases the number of claims that one adjuster can handle. However, those working towards a job in this field need not feel threatened. As long as a the number of insurance policies being sold, in an effort to provide a continuously growing population with adequate services, continues to increase, there will always be a need for insurance adjusters, examiners, appraisers, and investigators. Additionally, as the population of elderly increases, a greater need for healthcare will result in more claims.

The jobs performed by insurance adjusters, examiners, appraisers, and investigators are not easily automated. Even with all of the recent gains in productivity due to an uprising of technological advances, adjusters are still needed to contact policy holders, consult with experts, and inspect damage. Although still needed, the demand for insurance investigators is not expected to grow significantly over the next few years. Despite the expected rise in the number of claims in litigation and increased complexity of insurance fraud cases, technology such as the Internet makes it possible for existing investigators to handle more cases. Competition for careers in investigation will remain intense because of the many qualified people, including retirees from law enforcement and military careers, as well as experienced claims adjusters and examiners, who are drawn towards this area of employment each year.

Employment of auto damage appraisers is also expected to grow along with the average for all occupations through 2012. More claims continue to be filed and require attention due to the increasing number of auto insurance policies being sold. Because most appraisals require an on-site inspection, the work of this occupation is not easily automated. However, due to technological advancement many industries are downsizing as appraisers become more efficient. This will keep employment growth in this area limited as time goes by. In addition, the need for auto damage appraisers by be reduces as more and more insurance companies are open their own repair facilities.

Historical Earnings Information

Earnings of claims adjusters, examiners, and investigators vary significantly. In the year 2002 median annual earnings were found to be $43,020. Accordingly, the middle 50 percent earned between $ 33,120 and $ 56,170, and the lowest 10 percent earned less than $ 26,680. And the highest 10 percent earned more than $71,350.

As part of their job additional bonuses or benefits are often given to many claims adjusters; especially those working for large insurance companies. Laptop computers, cellular telephones, and company cars or reimbursement for the use of their own vehicle for business purposes, are other additional perks offered to a lot of claims adjusters.

In 2002, median annual earnings of auto damage insurance appraisers were $42,630. The middle 50 percent earned between $34, 570 and $52,360, while the lowest 10 percent made less than $27,410. The highest 10 percent reached earnings of more than $60,470.

Median annual earnings of auto damage insurance appraisers were $42,630 in 2002. The middle 50 percent earned between $34,570 and $52,360. The lowest 10 percent earned less than $27,410. And the highest 10 percent earned more than $60,470.