Claims Adjuster Job Description

Claims Adjuster Job Description

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Claims adjuster provides claims advice to clients and internal stakeholders in relation to reporting and monitoring of claims activity, claims reviews and audits, advice on industry claims experience.

Claims Adjuster Duties & Responsibilities

To write an effective claims adjuster job description, begin by listing detailed duties, responsibilities and expectations. We have included claims adjuster job description templates that you can modify and use.

Sample responsibilities for this position include:

Under technical direction, works within significant limits and authority in order to analyze claim forms, policies and endorsements, client instructions and other records to determine whether the loss falls within the policy coverage
Document claims file to comply with company guidelines and state regulations
Correct claims as required for settlement utilizing established policies and procedures
Reviews providers’ disputes and appeals, for professional and hospital claims, to determine resolution according to policies and procedures
Review all new Employer’s Reports of Occupational Injury or Disease assigned by the Unit Claims Supervisor
Determine compensability and accept or deny the claim (denials require Claims Supervisor’s Approval)
Handle all catastrophic cases or those lost time claims with an estimated disability period in excess of seven days, as determined by the Unit Claims Supervisor
Secure wage information, establish the average weekly wage and determine the appropriate compensation rate
Complete and file the appropriate Pennsylvania workers’ compensation forms
Evaluate the file’s ultimate probable claim cost and set a reserve accordingly

Claims Adjuster Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Claims Adjuster

List any licenses or certifications required by the position: AIC, CPCU, ASE, ARM, ANFI

Education for Claims Adjuster

Typically a job would require a certain level of education.

Employers hiring for the claims 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, Associates, Management, Technical, The College, Business/Administration, Communication, Public Administration, Legal

Skills for Claims Adjuster

Desired skills for claims 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
Coverages provided within various homeowner policies
Regulations
Disability duration
Medical management practices and Social Security and Medicare application procedure as applicable to line of business
Offsets and deductions
Claims handling procedures and operations
Policies

Desired experience for claims adjuster includes:

Authorize the payment of indemnity benefits within respective authority level
Develop a proactive case / disability management plan for the file designed to result in the injured worker returning to work as soon as possible
Identify negligent 3rd parties for subrogation purposes
Negotiate and settle workers’ compensation claims within your level of authority
Perform special projects as assigned by the Claims Supervisor or Manager
Bachelor's degree in related field, AIC or AIM designation encouraged but not required

Claims Adjuster Examples

1

Claims Adjuster Job Description

Job Description Example
Our innovative and growing company is hiring for a claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims adjuster
  • The candidate must have excellent interpersonal skills and strong verbal and written communication skills
  • Knowledge of claims database systems is preferred
  • Takes recorded statements from claimants, insureds, witnesses, and prepares summaries
  • Conducts investigations into minor single and multi-car accidents to obtain additional claims and coverage information and assist in determining liability
  • Reviews investigation notes and determines claim value, coverage and liability for basic claims
  • Properly screens self-pay patients for a variety of third-party payer programs according to the guidelines of the reimbursement programs
  • Updates and completes proper forms and documentation according to Company procedure for the coding, closing and suspending of accounts
  • Assist patients with the appropriate paperwork and ensure timely filing of the MVA claims
  • Maintains progress on all suspended accounts
  • Prepared lien documents and submits to county entity via electronic recording process or coordination with on-site staff
Qualifications for claims adjuster
  • ACII qualified or progress towards completion of insurance qualifications is preferred or legally qualified
  • Good communication, investigation and analytical skills
  • Experience of ECF repository and CLASS is preferred
  • Ability to work under own initiative with minimum supervision part of a team
  • Ability to perform basic math calculations (addition, subtraction, multiplication, and division) the calculation of averages and percentages
  • Associates Degree in Business field or equivalent experience preferred
2

Claims Adjuster Job Description

Job Description Example
Our company is searching for experienced candidates for the position of claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims adjuster
  • High School equivalency, bachelor’s degree in a related discipline is preferred
  • Interview with claimant and witnesses gather information police and hospital records, estimates to determine injuries
  • This position reports to the Unit Manager
  • Claims handling experience and working knowledge of auto and mortgage Lender placed or Force placed Insurance preferred
  • Develop and maintain knowledge to moderate level of medical terminology and demonstrate translation in to layman terms on a day to day basis
  • Evaluate medical claims that suspend within the Medical Claims System utilizing EmblemHealth’s PPO proprietary conventional coding structure
  • Utilizing Claims Operation’s C-More Adjudication Guidelines portal, reference QA memorandums, training guidelines, departmental memos, PRG’s, and apply business rules to claims as instructed for adjudication
  • As necessary, manually price claims utilizing the appropriate rate files while considering the provider’s network and the beneficiary’s insurance policy
  • As needed, access PPO’s PC Helper applications such as CWI-Viewer Application, Anesthesia Calculator, PC History Look-Up and any other helper application developed by GHI to support claims processing
  • Perform any projects delegated by claims supervisor
Qualifications for claims adjuster
  • Knowledge of auto insurance
  • Healthcare knowledge a plus (but not required)
  • Automotive Technical Abilities / hands on Technician experience
  • Automobile Servicing / Repair Experience
  • Self-motivated team player with good communication skills (verbal and written)
  • Excellent decision making, negotiation and conflict resolution skills
3

Claims Adjuster Job Description

Job Description Example
Our growing company is looking to fill the role of claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims adjuster
  • Perform a variety of tasks under the direction of management to investigate, evaluate, claims according to the company standards, the Nevada Innkeepers Statute and applicable insurance coverage
  • The position will have no settlement authority but will train to understand settlement rational
  • Responsible for answering phones, routing calls and providing general information to guests
  • Prepares written correspondence, file, fax, photocopy and process incoming and outgoing mail
  • Assist the Claims Representatives with support as needed
  • Support the management of the department as needed
  • Weekend “on-call” responsibility once the employee has satisfactorily learn the department procedure as support for the primary on-call Claims Representative
  • Take responsibility for handling various accounts within the Casualty claims team
  • COLLABORATE.Be part of a team dedicated to AAA members and one another
  • Analyze and process claims, correspondence and status inquiries from both providers and members
Qualifications for claims adjuster
  • Previous automotive / technical experience at either a manufacturer or dealer level is required, especially in the Parts and Service area
  • Working knowledge of Microsoft Office Suite and other PC applications
  • ASE Automobile & Light Truck Certified Preferred
  • Excellent computer skills including are needed due to multiple claim systems and automated recovery tools such as ISO, Arbitration Forums
  • Ability to carry out detailed written or verbal instructions
  • Ability to perform 80 percent sedentary work, exerting up to 10 pounds of force occasionally and negligible force frequently or constantly to move objects, including the human body
4

Claims Adjuster Job Description

Job Description Example
Our growing company is hiring for a claims 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 claims adjuster
  • Ensure the resolution of claim issues routed for clarification
  • Denies, settles, or authorizes payments to a wide range of property/casualty claims based on coverage, appraisal, and verifiable damage
  • Corresponds with policyholders, claimants, witnesses, attorneys, to gather important information to support contested claims in court
  • Resolves complex claims- such as BI, FIRE, LIT
  • Acts as lead when needed for back up or absent Lead
  • Handles claims following our client’s best practices and standard work which may include, but is not limited to, underinsured motorist, fatalities, and mediation/litigation management
  • May handle claims that involve medical payments and/or Personal Injury Protection (PIP)
  • Provide industry-leading customer service and works with business partners to deliver seamless claim service
  • Evaluates and settles bodily injury and property damage claims
  • Help guide customers, over the phone, through the claims process by investigating how their auto accident occurred and ensuring that their claims experience is a smooth as possible
Qualifications for claims adjuster
  • Administers claims of numerous ancillary products that are financed when a customer purchases a vehicle
  • College degree is not a prerequisite for this position
  • Resident license required
  • Multiple state licenses preferred
  • Bachelor’s degree in related field from four-year college or university preferred
  • Licensed in multiple jurisdictions
5

Claims Adjuster Job Description

Job Description Example
Our company is growing rapidly and is hiring for a claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims adjuster
  • Comfortable with manipulating data and producing reports
  • As an Inside Liability Determination Adjuster, you will play a vital role to ensure we deliver on our promise to help restore people’s lives after they experience a loss
  • You will analyze police reports and interview parties involved in accidents via the phone, to evaluate the cause of the accident, who’s at fault, and to what degree
  • Research and respond to moderately complex and occasionally complex customer communications, concerns, conflicts or issues
  • Summarize and document a claim file with notes, evaluations and decision making process
  • Provide overview of coverage limits in moderately complex and occasionally complex claims
  • Take recorded statements from involved participants, witnesses, medical providers, , conduct investigations into moderately complex and occasionally complex auto accidents, determine liability, and prepare summaries
  • Negotiate and settle claims in accordance with business unit best practices and determined claim value
  • The candidate should be handle associated claims under CLH (Charterer’s Liability to Hull)
  • Provide timely response to and/or the closure of the claim, with fair treatment and adequately reflecting actual liability
Qualifications for claims adjuster
  • Ability to organise workload, under pressure, whilst meeting tight deadlines
  • On-call = None
  • TBD Adjuster's licenses must be secured within 60 days of employment
  • Required to obtain an adjuster license in some states once hired
  • Training will be 6 weeks M-F 8-5 – 100% attendance required
  • This position will be filled in Troy, NY

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