Insurance Claims Adjuster Job Description

Insurance Claims Adjuster Job Description

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Insurance claims adjuster provides timely and accurate feedback on claim quality as measured by compliance with company and state-regulated standards.

Insurance Claims Adjuster Duties & Responsibilities

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

Sample responsibilities for this position include:

Apply broad knowledge of Company policy, regulatory standards to investigate and evaluate large fire and water damage claim
Assist our clients by skillfully guiding them through their claims experience from the first call to the final call
Investigate automobile claims, within your authority limit, for clients while following departmental standards and guidelines
Apply disciplined risk management and abide by industry regulatory practices
Contribute to the overall team’s success by taking ownership for personal and collective high performance
Perform fact finding regarding crop damage
Manages, investigates, and resolves claims
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation
Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status
Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action

Insurance Claims Adjuster Qualifications

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

Education for Insurance Claims Adjuster

Typically a job would require a certain level of education.

Employers hiring for the insurance claims adjuster job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Medical, Health, Finance, Accounting, English, Writing, Business, History, Management, Economics

Skills for Insurance Claims Adjuster

Desired skills for insurance claims adjuster include:

Microsoft Office software
Company policy
Conservatorship
Estate appointee requirements and state specific revocation laws
Minor beneficiaries
Misrepresentation
Pre-existing conditions
State regulatory compliance guidelines
Compliance and fair claims practices
MS Office

Desired experience for insurance claims adjuster includes:

Bachelor’s degree in risk management or related field is preferred
Successful demonstrated work experience in insurance claims is required
Must be computer literate in MS Access, Excel and Word
Accountable for security of financial processing of claims, security information contained in claims files
May assist in the absence of the Claims Team Manager, representing the company on matters involving state or federal regulatory agencies
Must have an advanced knowledge of coverage, liability, and complex claims handling procedures

Insurance Claims Adjuster Examples

1

Insurance Claims Adjuster Job Description

Job Description Example
Our company is looking for an insurance claims adjuster. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance claims adjuster
  • Handle all exposures of the claim including Dwelling, Other Structures, Contents and ALE
  • Maintain claim files, diary, and/or record keeping
  • Review and audit regularly
  • Interpret policy language
  • Setting educational goals to improve personal performance/continuing education for license if required
  • Engage and manage consultants and independent adjusters as required
  • Manages and oversees external Auto and General Liability claims adjusting process
  • Processes and adjusts internal minor Auto and General Liability claims
  • Coordinates and initiates action plans with Legal, Safety and Human Resources departments on new and existing accidents
  • Maintains database and prepares monthly reports for management detailing claims status and activity
Qualifications for insurance claims adjuster
  • Claims handling experience and working knowledge of auto and mortgage Lender-placed or Force-placed/Creditor-Placed Insurance (CPI) preferred
  • Experience in the mortgage industry with Real Estate owned (REO) or foreclosed/Lender owned properties a plus
  • Experience in the auto industry with lender placed insurance or repossessed collateral a plus
  • Intermediate to Advanced Level of Microsoft Office Suite
  • Industry license may be required
  • Must have or work towards obtaining appropriate states adjuster license (s) and continuing education credits
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Insurance Claims Adjuster Job Description

Job Description Example
Our growing company is looking for an insurance claims 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 insurance claims adjuster
  • Manages internal process for issuing 3rd party certificates of insurance and collection and tracking of vendor COI’s
  • Reviews insurance language in company leases and other contracts
  • Maintains and posts information on company investor relations web site
  • Coordinates investor relations meetings
  • Coordinates Quarterly earnings conference calls
  • Completes Treasury department duties as needed
  • Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries
  • Interpret contract benefits in accordance with specific claim processing guidelines
  • Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing
  • Minimal external contact with providers/agents/policyholders
Qualifications for insurance claims adjuster
  • Identifies possibly suspicious claims and claims requiring further investigation
  • Associate's Degree required, currently working towards Bachelor's degree strongly recommended for consideration
  • Typically has 1 to 2+ years' experience in customer service, financial services, banking, and or retail
  • Possesses excellent customer service skills and behaviors
  • Ability to adapt quickly to a fast paced learning environment
  • Texas Adjuster license
3

Insurance Claims Adjuster Job Description

Job Description Example
Our company is hiring for an insurance claims 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 insurance claims adjuster
  • Decision making of claims for these products, direct phone interaction with the customer
  • Utilizing established guidelines to obtain appraisals and other needed information from insured, advises insured as to proper course of action
  • Applies basic communication skills to interpret caller??s inquiries and offers options
  • Manages appraisal, rental, and vendor processes
  • Ability to handle Claims Service Rep
  • Compare data on claim forms against insurance plans to determine insurance coverage
  • Review completeness and validity of travel claims
  • Proactively resolve claims as expeditiously as possible and approve claims, when appropriate in accordance with policies and procedures
  • Calculate reimbursement of benefits according to the schedule of coverage
  • Generate claim reports, as directed by each account
Qualifications for insurance claims adjuster
  • High degree of self-motivation and critical thinking ability
  • Associate’s degree (AA) or equivalent from two year college or technical school desired
  • Minimum 1-2 yrs experience processing claims, end-to-end
  • PC/Windows experience needed
  • Investigative/analytical skills
  • A current Claims Adjuster License is a plus
4

Insurance Claims Adjuster Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of insurance claims 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 insurance claims adjuster
  • Timely phone and written correspondence with policyholder
  • Adequacy of reserves
  • Reviews coverage and policy status and requests necessary proof of loss documents
  • Reviews medical records and handles a caseload of Incontestable and Contestable claims
  • Directs vendor investigations as appropriate to secure medical records, criminal records or other information
  • Identifies possible fraudulent claims and refers to necessary agency/department
  • Acts in a leadership and supervisory capacity and has the ability to mentor and train
  • Performs many functions with limited or no direct supervision
  • Interacts by telephone and written correspondence with all levels of sales force, clients, attorneys, regulators, law enforcement officials and vendors
  • Investigate and adjust claims according to applicable laws and policy provisions
Qualifications for insurance claims adjuster
  • Excellent verbal and written communication skills and judgment, research, and organizational skills
  • Must have an energetic and positive attitude, serve as a key team player, and can easily adapt to new, different or
  • Changing situations
  • Include empathy, positive attitude and patience when communicating with customers
  • Others with enthusiasm to learn and grow within the industry
  • One to three years of experience in the areas of customer service, medical services, financial services, and/or working insurance claims knowledge preferred
5

Insurance Claims Adjuster Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of insurance claims 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 insurance claims adjuster
  • Reads, analyzes and interprets insurance policies and endorsements, applicable state and local statutes, case law, bulletins/decisions and applies to claims situations
  • Orders police reports and other records from ISO database and other sources to determine facts and prior accident information
  • Determines responsible parties and makes decisions regarding Company liability, questions of fraud or other pertinent issues
  • Orders bills and reports from medical providers of injured parties, and medical histories as needed
  • Examines and reviews potential subrogation claims and pursues subrogation according to Company guidelines
  • Prepares files for arbitration
  • Takes recorded statements as needed
  • Attends mediation on appropriate files
  • Assists in first and third party litigation
  • Handles claims on minor children and wrongful death including those sent to outside counsel
Qualifications for insurance claims adjuster
  • Superior attentiveness to detail and accuracy
  • Excellent writing skills for communication purposes
  • Proficient use of Microsoft Word, Excel, Outlook, and One Note
  • Experience billing Health insurance claims, for example, Kaiser, Medicaid, various State Agencies, Commercial Insurance, etc
  • Experience in the Health Insurance Arena (including billing of services via claim form, verification of insurance benefits, review of complex issues, experience in denials and appeals, payment entry and payment reconciliations
  • 3-5 years’ experience as a Life Insurance Claims Adjuster is required

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