Adjuster Job Description
Adjuster
provides prompt, friendly, courteous, accurate and helpful service including information about the claim handling process, claim number and general information questions.
Adjuster Duties & Responsibilities
To write an effective adjuster job description, begin by listing detailed duties, responsibilities and expectations. We have included adjuster job description templates that you can modify and use.
Sample responsibilities for this position include:
Investigates to establish the facts of claim, including evaluation of coverage, liability, and injuries
Works independently, evaluates legal liability and aggressively pursues, negotiates, and resolves subrogation collection
Resolves complaints, participates in arbitration and/or grievance procedures
Establishes immediate contact with Policyholders and claimants, conducts investigations, interviews insureds, witnesses and physicians, evaluates and makes recommendations regarding coverage
Sets and maintains adequate reserves, obtains reports and related materials, determines liability and total value of claim, and issues checks or declines payment
Develops and applies a working knowledge of legal and medical claims terminology and procedures
Reviews all accounts at resolution to ensure procedures have been followed for transmittal, closure and payment of fees by the hospital
Providing excellent customer service to customers and medical providers
Investigating, evaluation, and negotiating auto accident claims, in order to reach a fair and equitable settlement for all parties involved
Using compassionate communication and negotiation to ensure a positive customer experience
Adjuster Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Adjuster
List any licenses or certifications required by the position: AIC, CPCU, ASE, I-CAR, RHIT, ARM, ASD, WRT, IICRC, ANFI
Education for Adjuster
Typically a job would require a certain level of education.
Employers hiring for the adjuster job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Legal, Mathematics, Technical, Management, Engineering, Law, Associates, Business/Administration
Skills for Adjuster
Desired skills for adjuster include:
Claim file process through presentation of actions and responses to client questions
Accepted industry standards and practices Computer experience with related claims and business software
Accepted industry standards and practices
Coverage
Policies
Coverages provided within various homeowner policies
Liability
Procedures
Claim processes
Claim systems
Desired experience for adjuster includes:
CPT, ICD-9, Medical Terminology, COB/TPL/WC
Demonstrate ability to utilize Medical Terminology and International Classification Diagnosis (ICD-9), HCPCS&CPT coding at a level appropriate to the job
Reviews subpoenas and other documents related to moderate and occasionally complex litigation demands and prepares response
May prepare and negotiate moderate and occasionally complex subrogation issues or arbitrations
General office equipment experience
High School Diploma or Equivalent preferred3-5 years of claims examiner experience preferred
Adjuster Examples
1
Adjuster Job Description
Job Description Example
Our company is searching for experienced candidates for the position of adjuster. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for adjuster
- Investigates, reviews, and accepts or rejects moderately complex coverage and other potential coverage
- Controlling claim costs
- May assist junior adjusters
- Documents claim file to meet all company and state regulations
- Documents files and submits final report
- Within designated authority, negotiates with plaintiff attorney as required
- May be used as a technical resource by adjusters
- Reviews and evaluates claim based on evidence obtained in investigation
- Requests medical authorization from injured parties and submits claimant information to ISO database
- Reviews open files on a regular basis and makes contact with insureds, claimants or representatives to determine progress of claim
Qualifications for adjuster
- Claims System OCPS
- Excellent skills in communication Medical Claims Processing
- Prior PIP claims experience preferred
- Prior PIP claims or insurance experience preferred
- Ability to lift up to 50 lbs., carry 50 lbs., push 100 lbs., pull 75 lbs
- Exposure to noise
2
Adjuster Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of adjuster. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for adjuster
- Coordinates assignment of claims to other adjusters, provides training for other adjusters, and may serve on committees as needed
- Provides support to agency force, including policy interpretation, training and general understanding of Claims operations
- May be responsible for evaluating physical damage estimates and paying physical damage claims
- Responsible for reviewing assigned claims on a regular basis and accountable for maintaining accurate reserves
- Consults police and hospital records
- Handles complex losses locally unassisted up to designated authority
- Ability to perform the essential functions of the position with or without a reasonable accommodation
- Inspects damaged property, prepares estimates utilizing computerized estimating tools, and performs reinspections as needed
- Reviews open files and makes contact with insureds, claimants or representatives to determine progress of claim
- Participates in Examinations Under Oath, depositions, mediations and testimony during litigation process
Qualifications for adjuster
- Ability to use and understand adjusts and test stations including analog and digital test equipment, along with oscilloscopes
- Must be able to tolerate hot working conditions in the summer months
- Return ink, skids, cut blanks, to their assigned areas upon completion of order
- Review condition of all panel cutting dies with lead adjuster or supervisor once they are removed from machines
- Monitor machine shut downs where applicable to ensure proper wash up of machines at end of shift
- High School education or equivalent, with mathematics emphasis
3
Adjuster Job Description
Job Description Example
Our growing company is searching for experienced candidates for the position of adjuster. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for adjuster
- Serve as first line supervisor for Machine Operators and Bag Catchers
- Handle a small inventory of claims in addition to Lead Adjuster duties
- Complete open/closed file reviews
- Demonstrate high quality file handling and customer service
- Review checks for accuracy
- Assist in Quality Control auditing
- Professional interaction with claimants and client representatives with the goal of obtaining all necessary information to make payment decisions and recommendations for future management of moderately complex disability claims
- Identification of relevant claims issues, development of plans and processes to mitigate loss and expense payments
- Uses discretion and judgment in claim handling
- Possesses functional knowledge and skills reflective of study and/or on job development
Qualifications for adjuster
- Thorough knowledge of relay adjusting
- 2+ years of experience as a Machine Adjuster working with envelope machines (SW, SR, 102, 627)
- High degree of mechanical aptitude and previous assembly/production experience required
- Good communication skills, ability to work effectively with coworkers and communicate with all levels of management
- 1-2 years' demonstrated mechanical experience and previous printing experience preferred but not required
- Ability to work and meet deadlines with minimal direction
4
Adjuster Job Description
Job Description Example
Our company is hiring for an adjuster. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for adjuster
- Scope of handling includes Short Term claims with Long Term potential
- Reserving authority levels are intermediate and supervisory guidance is provided as appropriate
- May take recorded statements
- Processes small dollar value package claims damage
- Notifies shippers of damaged or lost goods
- Obtains and reviews photos of damaged package
- Ensures pertinent information is documented such as proof of value, replacement cost, reparability and salvage status, shipping charges
- Advises shipper of decision and sends appropriate claim form or denial letter
- Completes daily production spreadsheet and submits to supervisor
- Enters information into system for statistical purposes
Qualifications for adjuster
- Required High School Diploma/General Education Diploma (GED), 4 year degree preferred with emphasis on health administration
- Previous PIP experience is a plus but not required
- Medical background or experience with medical record analysis
- Participates in make ready and run operations
- Ability to scope, diagram and estimate damages
- Mobile home and Dwelling construction knowledge preferred
5
Adjuster Job Description
Job Description Example
Our innovative and growing company is looking for an adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for adjuster
- Processes medical bills and recognizes medical management opportunities
- Assesses medical/physical condition and prior injuries of claimant, and obtains and analyzes medical bills, wage loss reviews, home service or attendant care, mileage payments, and other related claims to determine reasonableness of charges and relation of injuries to accident, and to ensure compliance with fee schedules, and detect duplicate billing
- Conducts first party file processing/fact gathering, including interviewing claimant, witnesses, medical providers
- Evaluates medical records and treatment plan of claimant and determines if continued treatment is reasonable
- Determines appropriate benefit and negotiates and settles moderately complex claims, including resolution of moderately complex usual and customary billings
- Monitors treatment and benefit payments for excessive, unreasonable, or abusive claims
- Handles specialized claims
- Reviews subpoenas and non-complex demands (e.g., Florida demands)
- May prepare and negotiate moderately complex subrogation issues or arbitrations
- Manage consultants, that may include engineering, lawyers and forensic accountants
Qualifications for adjuster
- 2+ years of experience as a Machine Adjuster working with envelope machines
- Minimum 5 years previous experience as an outside casualty claims adjuster
- Must be licensed as required by local, state and federal laws
- Highly organized and self-directed with ability to handle multiple tasks
- Minimum 6 months previous experience as a Claims Adjuster
- Must be licensed as required by state and local jurisdictions