Claims Adjusters, Appraisers, Examiners, and Investigators

Claims Adjusters, Appraisers, Examiners, and Investigators typically perform the following 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. • Investigate and assess damage to property and create or review property damage estimates. • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims. • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review. • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation. • Resolve complex, severe exposure claims, using high service oriented file handling. • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies. • Confer with legal counsel on claims requiring litigation. • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments. • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis. • Refer questionable claims to investigator or claims adjuster for investigation or settlement. • Collect evidence to support contested claims in court. • Contact or interview claimants, doctors, medical specialists, or employers to get additional information. • Present cases and participate in their discussion at claim committee meetings. • Report overpayments, underpayments, and other irregularities.