Claims Adjusters, Examiners, and Investigators
O*NET files this work under Claims Adjusters, Examiners, and Investigators: people who review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. The strongest interest signal is Conventional (6.2 of 7), then Enterprising (4.8) and Investigative, which gives it the code CEI. The preparation level is considerable preparation, typically a bachelor’s degree plus a period of work experience. O*NET’s skill data points to reading comprehension, critical thinking, and active listening as the ones to build. You may also need to examine claims forms and other records to determine insurance coverage. It tends to suit people who want orderly work with data, records and clear procedures, and it offers little for anyone seeking creative work with room for original expression.
What they do
Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.
Main tasks
- Examine claims forms and other records to determine insurance coverage.
- Analyze information gathered by investigation and report findings and recommendations.
- Pay and process claims within designated authority level.
- Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
Skills
- Reading Comprehension
- Critical Thinking
- Active Listening
- Speaking
- Judgment and Decision Making
- Writing
Who this career fits
May suit you if
- You like clear rules and getting the details right.
- You like taking the lead and making the call.
- You are ready to spend around four years on a degree, then build experience.
- You are comfortable relying on reading comprehension and critical thinking.
May not suit you if
- You get restless with routine, records and exact procedures.
- You need creative expression to be a big part of your day. Artistic rates 1.0 out of 7 here.
- You want to avoid a four-year degree or its equivalent.
Interest profile
O*NET rates each occupation from 1 to 7 on six interest types. The code CEI takes the three highest, and Conventional comes first here.
Preparation
Considerable preparation. Most jobs here ask for a bachelor’s degree, and employers usually expect a few years of related experience as well.
Most-reported requirement in the O*NET survey: Bachelor's Degree. This reflects what workers reported most often and is not a legal minimum. Licensing rules can differ by state or industry, so confirm what applies where you plan to work.
Also called
- Claims Adjuster
- Claims Analyst
- Claims Examiner
- Claims Representative
- Claims Specialist
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This page includes information from the O*NET 31.0 Database by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA). Used under the CC BY 4.0 license. O*NET® is a trademark of USDOL/ETA.