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

The life insurance claims adjuster is responsible for reviewing and evaluating claims submitted by policyholders to determine the validity of the claim and the amount of benefits due. This process can be complex, as there are many factors to consider when assessing a claim. In some cases, the adjuster may need to review medical records, financial documents, and other materials.

If the claim is approved, the adjuster will decide on the amount of benefits to be paid and communicate this information to the claimant. The claims adjuster's decisions can have a significant impact on the financial well-being of a family if the claim is substantial, so it is important that they are accurate and thorough in their assessment.

Steps How to Become

1. Obtain postsecondary education. Most employers prefer that insurance claims adjusters have a bachelor's degree in business, finance, economics, accounting or a related field.
2. Obtain work experience. Although not always required, employers may prefer applicants who have previous experience in insurance, customer service, sales or finance.
3. Complete an insurance claims adjuster training program. Most employers require that insurance claims adjusters complete an approved training program to become certified. Training programs typically include coursework and hands-on experience.
4. Obtain a license. In some states, insurance claims adjusters must be licensed or certified. To become licensed, applicants must pass a written exam and submit to a criminal background check.
5. Obtain on-the-job training. Insurance claims adjusters receive on-the-job training from experienced adjusters. Training typically includes learning about the company's policies and procedures for filing and processing claims.
6. Obtain additional certifications. Insurance claims adjusters may choose to obtain additional certifications from organizations such as the American Institute for Chartered Property Casualty Underwriters (AICPCU). Certifications can demonstrate expertise in specific areas of adjusting and may help boost career prospects.

As a life insurance claims adjuster, it is essential to stay up-to-date and competent in order to effectively handle claims and provide accurate information to clients. To do this, one must stay educated on the latest developments in the life insurance industry, including changes in regulations, policies, and procedures. it is important to stay abreast of the latest technology used in the industry, such as the use of electronic claims processing systems.

Furthermore, it is beneficial to attend seminars and workshops related to the field to increase knowledge and understanding. Finally, it is important to stay connected with other professionals in the industry in order to ensure that one is in touch with the latest trends, as well as to build a network of contacts. All of these factors are essential for a life insurance claims adjuster to remain up-to-date and competent.

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Job Description

1. Investigate and analyze the validity of life insurance claims.
2. Determine the extent of the company’s liability for each claim.
3. Evaluate and negotiate settlements with claimants and attorneys.
4. Process claims in accordance with the applicable state insurance regulations.
5. Prepare reports and deliver findings to the insurance company.
6. Develop and maintain relationships with medical professionals and other witnesses.
7. Make recommendations on future claims handling procedures.
8. Coordinate with other departments to ensure accurate claim handling and compliance.
9. Identify potential fraudulent life insurance claims.
10. Liaise with claimants, attorneys and other parties to resolve disputes.

Skills and Competencies to Have

1. Analytical and Critical Thinking
2. Excellent Interpersonal and Communication Skills
3. Knowledge of Insurance Policies and Regulations
4. Negotiation Skills
5. Attention to Detail
6. Problem-Solving Abilities
7. Time Management
8. Computer Proficiency
9. Ability to Work Under Pressure
10. Ability to Analyze and Interpret Data

The most important skill for a life insurance claims adjuster is the ability to assess and analyze complex information and make decisions based on their findings. This requires strong analytical, research, and problem-solving skills. Having knowledge of legal and regulatory requirements related to life insurance policies is also essential.

The ability to effectively communicate with both the policyholder and the insurance company is also key, as this will help to ensure that the claim is managed appropriately. Furthermore, having excellent customer service skills will help the adjuster to build trust with policyholders, which can make the claims process run more smoothly. All of these skills are essential for a successful claims adjuster to handle the complexities of life insurance claims.

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Frequent Interview Questions

• What experience do you have in the life insurance claims adjustment field?
• How do you handle difficult insurance claims and how do you determine if a claim is valid?
• Are you familiar with state and federal regulations related to life insurance claims?
• Describe a situation when you had to negotiate with a claimant to reach a settlement.
• What strategies do you use to ensure a fair and accurate settlement?
• How do you stay up-to-date on changes in the insurance industry?
• What techniques do you use to gather evidence and documents for validating claims?
• What is your approach when dealing with customers who are unhappy with their claim settlements?
• What resources do you use when researching complex medical conditions or treatments for life insurance claims?
• Explain the process you use for managing multiple life insurance claims simultaneously.

Common Tools in Industry

1. Claims Management System. A computer system used to track and manage insurance claims, including tracking information related to policyholders, claimants, and their claims. (eg: ClaimCenter)
2. Claims Investigation Software. Software used to investigate and evaluate insurance claims, including the gathering and analysis of evidence and data. (eg: SIU Analyst)
3. Risk Assessment Software. Software used to assess the risk associated with a particular claim, including the cost of providing coverage for that claim. (eg: RiskMap)
4. Policy Administration System. A computer system used to manage the issuance and renewal of insurance policies, including tracking policyholder information and ensuring accuracy of coverage. (eg: PolicyCenter)
5. Document Management System. A computer system used to store and manage documents related to insurance claims, such as policy documents and claim forms. (eg: DocuSign)
6. Communication Software. Software used to facilitate communication between insurers, policyholders, claimants, and other involved parties. (eg: LiveChat)

Professional Organizations to Know

1. National Association of Insurance Commissioners (NAIC)
2. National Association of Independent Insurance Adjusters (NAIIA)
3. American Association of Insurance Services (AAIS)
4. National Association of Professional Insurance Agents (NAPIA)
5. International Association of Insurance Professionals (IAIP)
6. American Institute for Chartered Property Casualty Underwriters (AICPCU)
7. National Conference of Insurance Legislators (NCOIL)
8. Professional Liability Underwriting Society (PLUS)
9. Chartered Property Casualty Underwriter (CPCU)
10. Society of Chartered Property and Casualty Underwriters (SCPCU)

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Common Important Terms

1. Beneficiary. A person who is designated to receive benefits or payments from an insurance policy.
2. Death Benefit. The money paid to the beneficiary of a life insurance policy upon the death of the insured person.
3. Claim. A demand made by the insured or their beneficiary to an insurance company for payment of the benefits due under an insurance policy.
4. Investigation. The process of gathering information in order to make a determination about a claim.
5. Underwriting. The process of evaluating a potential insured person to determine whether they are eligible for coverage and what terms and conditions should apply to their policy.
6. Premium. The amount of money paid by an insured person to an insurance company for coverage.
7. Policy. A legally binding contract between an insured person and an insurer that outlines the terms of the agreement, including benefits and conditions for payment.

Frequently Asked Questions

What is a Life Insurance Claims Adjuster?

A Life Insurance Claims Adjuster is a professional who assesses and settles life insurance claims on behalf of insurance companies. They review the details of the claim, investigate any suspicious activity, evaluate the amount of coverage owed to the policyholder, and ultimately decide whether or not to approve the claim.

What qualifications are required to be a Life Insurance Claims Adjuster?

To become a Life Insurance Claims Adjuster, you must have a minimum of two years of related work experience and a bachelor's degree in a related field such as accounting, finance, or risk management. It is also beneficial to have knowledge of the policies, procedures, and regulations applicable to the insurance industry.

What types of tasks does a Life Insurance Claims Adjuster perform?

A Life Insurance Claims Adjuster may review and analyze claim documents, interview claimants, investigate suspicious activity, and evaluate the amount of coverage due to the policyholder. They may also negotiate settlements, recommend denial or approval of claims, and provide customer service to claimants and other parties involved in the claim process.

What skills and abilities are important for a Life Insurance Claims Adjuster?

A Life Insurance Claims Adjuster should possess excellent problem-solving skills, analytical skills, communication skills, and customer service skills. They should also be able to work independently, multi-task effectively, and manage their time efficiently.

What is the average salary for a Life Insurance Claims Adjuster?

The average salary for a Life Insurance Claims Adjuster ranges from $50,000 to $80,000 per year depending on experience and location.

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Web Resources

• Insurance Claims Adjuster - Florida State College at Jacksonville www.fscj.edu
• Insurance Claims Adjuster Training Online | USCI www.uscareerinstitute.edu
• Online Insurance Claims Adjuster Course - U.S. Career Institute www.uscareerinstitute.edu