Claims Adjusters, Appraisers, Examiners, and Investigators

You should be a strong critical thinker with great interpersonal skills and communication skills; a little interest in detective work will be icing on the cake to become Claims Adjusters, Appraisers, Examiners, and Investigators.

Claims Adjusters, Appraisers, Examiners, and Investigators mainly act as intermediaries between insurance companies and public. They 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. Appraisers estimate the cost or value of an insured item.

Claims examiners review claims after they are submitted to ensure that proper guidelines have been followed by claimants and adjusters.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments.

Role of Claims Adjusters, Appraisers, Examiners, and Investigators

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
Keep claims files, such as records of settled claims and an inventory of claims requiring detailed analysis
Negotiate settlements
Authorize payments

Academic Qualification of Claims Adjusters, Appraisers, Examiners, and Investigators

Though no formal qualification is there for a Claims Adjuster, but a bachelor's degree program in business administration can help a student choose a specific area. Some possible areas include accounting, marketing, management, finance and entrepreneurship. MBA students can also pursue this profession in India.

Skills of Claims Adjusters, Appraisers, Examiners, and Investigators

Analytical skills: Adjusters and examiners must have analytical skills so insurance company pays a fair claim and carefully consider various pieces of information to reach a decision.

Communication skills: Claims adjusters and investigators get information from a wide range of people, including claimants, witnesses, and medical experts so they need sound communication skills.

Interpersonal skills: Adjusters, examiners, and investigators workers must be understanding and yet firm with their company’s policies.

Math skills: Appraisers must be able to calculate property damage.

Work Schedules

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

Adjusters often work during weekend and arrange their work schedules to accommodate evening appointments with clients. They have irregular schedules. 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.

Scope of Claims Adjusters, Appraisers, Examiners, and Investigators

Claims adjusters are employed by insurance companies and also by individuals who want to offset some of the cost for their loss.Some claims adjusters work as public adjusters. Claims examiners review claims after they are submitted to ensure claimants and adjusters followed proper guidelines. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases. In India, they work as Claims Adjuster, Claims Representative, Claims Examiner, Claims Analyst, Claims Specialist, Claim Representative and Litigation Claim Representative.

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