How to Be Insurance Claims Adjuster - Job Description, Skills, and Interview Questions

Jan 20, 2021 / 5 Minutes Read / By Albert

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When a claim is made on an insurance policy, an insurance claims adjuster is brought in to assess the situation. They review the claim, investigate the facts, and evaluate the damages. After this evaluation, the adjuster will determine the amount of money the insurance company should pay and also make sure that any legal requirements are met.

The adjuster's determination will often be the deciding factor in how much money the policyholder will receive for their claim. In addition, the adjuster's work helps to ensure that insurance companies don't pay out more than they should and that policyholders get the compensation they deserve.

Steps How to Become

Review the Requirements. Different states have different requirements for becoming an insurance claims adjuster. Most require you to become licensed and you may need to complete pre-licensing education and pass an exam. Check with your state licensing board to find out what is required in your state.
Complete Pre-Licensing Education. Most states require pre-licensing education before you become an insurance claims adjuster. This can be completed either online or in a classroom setting, depending on the requirements of your state. The courses will cover key topics such as insurance principles, regulations and claim handling procedures.
Pass the Licensing Exam. Once you have completed the pre-licensing education, you will need to take and pass the licensing exam. The exam is administered by the state licensing board and covers key topics such as legal principles, insurance regulations and claim handling procedures.
Submit Licensing Application. After passing the exam, you will need to submit an application to the state licensing board. This will include your background information, pre-licensing education certificates, passing exam results and any other required documentation.
Obtain Errors and Omissions Insurance. Most states require insurance claims adjusters to have errors and omissions insurance. This coverage protects the adjuster from any claims that may arise from their work.
Start Adjusting Claims. Once you have been licensed, you can start adjusting claims for insurance companies. You will investigate claims, evaluate losses and negotiate settlements with policyholders.

The cause and effect of becoming a skilled and qualified insurance claims adjuster requires the right combination of education, experience, and certifications. To become a successful insurance claims adjuster, it is important to acquire the necessary training and experience needed to effectively handle the claims process. This includes completing an appropriate educational program, such as a degree in insurance, finance, or business management.

gaining hands-on experience in the insurance industry is invaluable, as it gives the individual an opportunity to apply the skills and knowledge acquired in their education. Finally, obtaining the necessary certifications, such as those offered by the Insurance Institute of America, is essential for becoming a competent insurance claims adjuster. With the right combination of education, experience, and certifications, an individual can become a skilled and qualified insurance claims adjuster.

You may want to check Insurance Risk Manager, Life Insurance Agent, and Insurance Program Manager for alternative.

Job Description

Investigates insurance claims to determine the extent of the insurance company's liability and negotiates settlements.
Reviews all documentation related to the claim, including police reports, medical records and damage appraisals.
Interviews claimants, witnesses and medical experts to determine who is at fault for the incident and the extent of the damages incurred.
Evaluates all evidence and determines the validity of claims.
Determines the amount of compensation to be paid to the claimant, taking into account the claimants losses, the policy limits and applicable laws.
Documents all settlements and maintains claim files.
Negotiates with attorneys, claimants and other parties in order to resolve complex claims.
Stays current on changes in the insurance industry and applicable laws.
Provides expert testimony in court when necessary.
Develops strategies to reduce future claims and expenses.

Skills and Competencies to Have

Excellent communication and interpersonal skills
Strong analytical and problem-solving skills
Knowledge of insurance law, regulations, and industry standards
Ability to make sound decisions quickly
Proficiency in using computers and software applications
Ability to work independently or as part of a team
Detail-oriented and organized
Ability to handle multiple tasks simultaneously
Ability to work under pressure and meet deadlines
Ability to effectively negotiate with claimants and other parties

The job of an Insurance Claims Adjuster is a vital role within the insurance industry and requires an individual with a thorough understanding of the claims process. To be successful in this role, an individual must possess strong communication and negotiation skills, analytical and problem solving abilities, a keen eye for detail, and an ability to work both independently and as part of a team. an adjuster must have a comprehensive knowledge of the industry, the policy provisions, and the laws that govern insurance contracts.

Having these skills allows an adjuster to effectively evaluate claims and make accurate decisions based on the evidence presented. This in turn allows insurance companies to settle claims quickly and fairly, ensuring that customers are satisfied with their coverage and protecting the company from financial losses.

Automobile Insurance Agent, Title Insurance Agent, and Reinsurance Underwriter are related jobs you may like.

Frequent Interview Questions

What experience do you have working with insurance claims?
How do you handle difficult customer interactions?
What techniques do you use to investigate and analyze claims?
How do you stay organized and manage multiple claims?
What steps do you take to ensure accurate and timely claim settlements?
How do you handle disputes with claimants or other parties?
How do you keep up with changes in the insurance industry?
What measures do you take to remain compliant with relevant laws and regulations?
What strategies do you use to prevent fraudulent claims?
Describe a time when you had to make a difficult decision regarding a claim.

Common Tools in Industry

Estimate Software. Software used to create detailed estimates of cost and time needed to repair an insurance claim. (Eg: Xactimate)
Digital Camera. Used to document the damages that have been incurred and to record the progress of repairs. (Eg: Canon EOS Rebel)
Smartphone. Used to access digital maps and navigation, as well as to contact clients and other professionals. (Eg: iPhone 11)
Laptop/Tablet. Used to store and access claim information, as well as research policy coverage and claim processes. (Eg: Microsoft Surface Pro)
Policy Research Software. Software used to research policy coverage and other legal documents related to claims. (Eg: LexisNexis)
GPS Tracking Device. Used to track the location of a claim adjuster while on the job. (Eg: Garmin GPS)

Professional Organizations to Know

National Association of Independent Insurance Adjusters (NAIIA)
Claims and Litigation Management Alliance (CLM)
Professional Liability Underwriting Society (PLUS)
American Association of Insurance Services (AAIS)
American Risk and Insurance Association (ARIA)
The Institutes Risk and Insurance Knowledge Group (IRIKG)
Council on Litigation Management (CLM)
National Association of Insurance Commissioners (NAIC)
International Association of Insurance Professionals (IAIP)
National Conference on Public Employee Retirement Systems (NCPERS)

We also have Insurance Loss Control Specialist, Health Insurance Agent, and Insurance Underwriter jobs reports.

Common Important Terms

Claims Examiner. A claims examiner is responsible for reviewing, evaluating and processing insurance claims to ensure proper coverage and payment.
Actuary. An actuary is a professional who assesses risk and calculates premium rates in the insurance and finance industries.
Underwriter. An underwriter is a financial professional who evaluates and approves insurance applications and reviews policies to assess their risk.
Risk Manager. A risk manager is an individual or group of professionals who assess, evaluate and manage risk in order to mitigate potential losses.
Insurer. An insurer is an individual or company that provides insurance to policyholders.
Policyholder. A policyholder is an individual or organization that has an insurance policy with an insurer.
Reinsurance. Reinsurance is the practice of transferring risk from one insurer to another insurer, usually in exchange for a premium payment.
Claims Adjuster. A claims adjuster is responsible for investigating and settling insurance claims on behalf of an insurer.

Frequently Asked Questions

What is a Claims Adjuster?

A Claims Adjuster is a professional who investigates, evaluates and resolves insurance claims for individuals and businesses.

What qualifications does a Claims Adjuster need?

Claims Adjusters typically need a bachelor's degree and must have a license from the state in which they are practicing. They must also have knowledge of insurance policies and procedures, as well as an understanding of medical terminology and legal aspects of insurance claims.

What is the average salary of a Claims Adjuster?

According to the U.S. Bureau of Labor Statistics, the median annual salary for Claims Adjusters was $63,380 in May 2019.

What duties does a Claims Adjuster perform?

A Claims Adjuster typically reviews insurance policies, interviews claimants and witnesses, inspects property damage, evaluates medical reports, assesses liability and determines the amount of compensation due to an insured party.

What type of environment does a Claims Adjuster work in?

Claims Adjusters usually work in an office setting; however, they may also travel to investigate claims or visit claimants at their homes or places of business.