Main Responsibilities and Required Skills for Adjuster
An Adjuster is a person who investigates insurance claims on behalf of insurance companies, to determine the amount of money that should be paid to the policyholder or to third parties who have suffered damages. They review damages and damage assessments, interpret insurance policy wordings, and determine coverage. In this blog post we describe the primary responsibilities and the most in-demand hard and soft skills for Adjusters.
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Main Responsibilities of Adjuster
The following list describes the typical responsibilities of an Adjuster:
Address
Address salvage and subrogation as required by the client.
Adhere to
Adhere to Corporate Guidelines, Company Claim Bulletins, and the Company Code of Ethics.
Adhere to specific client instructions and assignment requests.
Analyze
Analyze data and present ideas effectively both orally and in writing.
Analyze, evaluate and negotiate claims of minimal complexity.
Analyze the information, interpret insurance policy wordings, determine coverage and assess damage.
Apply
Apply advanced knowledge of training facilitation and coaching skills.
Apply basic knowledge of negotiation and / or appraisal skills.
Apply broad knowledge of insurance policy, coverage, and regulation.
Apply broad knowledge of problem solving and preparation of reports for analysis.
Apply broad negotiation and / or arbitration skills.
Apply broad problem solving skills to continuously improve business outcomes.
Apply general negotiation and / or arbitration skills.
Apply understanding of regulatory requirements and standard process for claim handling.
Arrange
Arrange insurer examinations as needed.
Assign
Assign and correspond with independent adjusters as needed.
Assist with
Assist in the development and implementation of training programs.
Assist Manager with preparing / completing monthly statistical reports.
Assist with claims from desk adjusters when on-site inspections are required.
Assist with various accounting functions as assigned.
Attend
Attend legal proceedings in the course of subrogation litigation handling.
Attend mediation, if required.
Attend and participate in ongoing training.
Chase
Chase Recovery after the settlement of the Claim if required.
Claim
Claim may involve litigation, arbitration or mediation requiring coordination with legal counsel.
Claim Payment Processes – Issuance and Authority.
Collect
Collect and review documents and other relevant information.
Communicate
Communicate with brokers and underwriters.
Complete
Complete and monitor timely WC payments / state filings.
Complete and reviews contents inventory, contents pricing, and analysis.
Complete and reviews contents inventory, contents pricing, and mitigation bills.
Complete complex and occasionally highly complex attorney bill reviews.
Complete quantum assessments and proposals on files.
Comp;u
Complies with Unfair Claim Practices Acts and handles claims in good faith.
Condition
Condition vehicles and prepare valuation reports for customers to settle total loss claims.
Conduct
Conduct fast track estimating.
Conduct subrogation investigations.
Consider
Consider and recommend use of experts and reviews reports.
Coordinate
Coordinate services with vendors and service providers.
Correct
Correct information provided in the insurance application, if necessary, prior to claim payment.
Determine
Determine liability and course of action.
Determine liability and look for opportunities to subrogate.
Determine policy coverage, establish and adjust financial reserves, and comply with the legislation.
Determine priority of payments and assessment & calculation of benefit entitlements.
Determine subrogation / salvage amounts applicable and payable, and ensure appropriate reserving.
Determine the acceptability of high value shipments.
Determine valuation of salvage.
Determine whether to accept or deny a claim based on all documentation received.
Develop
Develop entry level claim negotiation and settlement skills.
Direct
Direct field investigations as required for exposure and within account guidelines parameters.
Direct reporting line to Claims Team Manager.
Direct vendor partners as necessary.
Ensure
Ensure adherence to best practice procedures for each line of business within allocation.
Ensure all phone messages are responded to promptly and within required timelines.
Ensure claims are properly investigated, evaluated, and resolved in a timely manner.
Ensure complex cases are managed effectively.
Ensure security and confidentiality of sensitive and / or protected information.
Ensure service levels and quality standards are met by approved specialists.
Ensure the accurate and efficient payment of claims.
Ensure timely follow-up with customers on the status of their claims.
Ensure work is processed timely and efficiently.
Estimate
Estimate water damage in a dwelling, hail damage, and smoke or fire damage.
Evaluate
Evaluate all information to determine how claim should be handled.
Evaluate and settle assigned claims based upon investigation results.
Evaluate and settle assigned claims based upon the results of the investigation.
Evaluate damages and pay benefits as prescribed by law and policies and procedures.
Evaluate diminished value in a moderately complex claim.
Examine
Examine insurance policies and other records to determine insurance coverage.
Fill out
Fill out the required production monitoring and quality control forms.
Follow up
Follow up on pending files and on-going claims.
Gather
Gather facts in order to determine liability and coverage.
Handle
Handle all kind of Complex losses within authority limits.
Handle and process personal injury and various claims.
Handle higher level of complexity claims Complex losses within authority limits.
Handle inside investigation of mortgagee claims.
Identify
Identify possibly suspicious claims and claims requiring further investigation.
Identify subrogation opportunities and fraud potential and make appropriate.
Implement
Implement and organize strategy for managing pending of ongoing files.
Include
Include others in the decision-making process as warranted.
Initiate
Initiate initial claims handling.
Inspect
Inspect and estimate damage in a dwelling.
Inspect scope, approve, and adjust estimates of damage, as well as determines loss amounts.
Interact with
Interact extensively with various parties involved in the claim process.
Interact with insurance carriers and healthcare providers to secure records and account balances.
Interface with
Interface with customers, agents, dealers to complete all investigations of claims.
Interpret
Interpret and apply all state and storm issues across all states.
Interpret claim history coverages.
Interpret reports in order to draw accurate conclusions about proposed treatment and / or actions.
Investigate
Investigate and negotiate property claims in accordance with Aviva's claim procedures and guidelines.
Investigate, evaluate and settle entry-level insurance claims.
Investigate, review and accept or rejects coverage and other potential coverage.
Investigate, review, determine and verify moderately complex coverage / policy information.
Keep
Keep defence costs to a minimum by obtaining waiver, then legal opinions only to resolve files.
Keep insured / claimant / broker fully informed of the status of the claim.
Maintain
Maintain a mobile office for settling claims.
Maintain an excellent working relationship with existing clients to further develop business.
Maintain a professional demeanor and image in accordance with Company policies and expectations.
Maintain a valid claims adjuster license in all states that require a license.
Maintain constructive working relationships despite differing perspectives.
Maintain cost control over claims expenses.
Maintain professional and safety standards required by Seek Now and its insurance carrier clients.
Maintain professional and technical knowledge through continuing education.
Maintain proper account documentation.
Maintain punctual attendance in accordance with assigned work schedule.
Maintain relevant knowledge necessary to perform essential job functions.
Make
Make and maintain a connection with the customer by understanding and meeting their needs.
Make initial contact per account guidelines.
Manage
Manage claims in litigation, participate in mediations, pre-trials and settlement conferences.
Manage diverse levels of liability claims.
Manage increased settlement authority, beyond that of a Claims Adjuster II.
Manage phone calls and e-mails in a fast-paced environment.
Manage subrogation and litigation of claim as it applies.
Monitor
Monitor the quality of the final product.
Negotiate
Negotiate and settle claims pro-actively in accordance with Company guidelines and best practices.
Negotiate and settle moderately complex claims in accordance with business unit best practices.
Negotiate and settles claims in accordance with business unit best practices.
Negotiate repair process with body shops.
Nurture
Nurture relationships with customers, repair centers, part suppliers, and other vendors.
Obtain
Obtain recorded statements from claimants.
Order
Order police reports, Set-up new claim files, confirmation of loss to insurer & broker.
Organize
Organize and reconcile bills.
Participate
Participate in claims dispute resolution process as required.
Perform
Perform entry-level workers' compensation claims administration.
Perform maintenance on machine.
Perform make ready's on all straight line and auto-bottom boxes.
Perform other duties as assigned.
Perform recycled and accessory parts searches.
Perform related work as assigned.
Prepare
Prepare basic and occasionally moderately complex damage estimates.
Prepare basic damage estimates.
Prepare damage estimates for moderately complex or occasionally complex claims and locates parts.
Prepare estimates and valuations of the damage or loss.
Prepare estimates for cost of repair and / or replacement.
Prepare estimates of damage or loss where required.
Prepare referrals to Home Office.
Prepare / reviews / approves complex and occasionally highly complex damage estimate.
Process
Process claims payments.
Process file accounts and expenses for payment and submits for approval where required.
Process medical bills and recognizes medical management opportunities.
Process salvage titles, and monitors salvage recoveries.
Promote
Promotes and facilitates free and open communication.
Prompt
Prompt contact and follow up with policy holders and claimants.
Provide
Provide advanced individual decision making within authority limits.
Provide all parties with claim process and status as appropriate.
Provide claim status to stations and customers verbally / in writing.
Provide clear and concise information to vendors.
Provide direction to processors and supports management.
Provide high level of customer service to clients and insured's.
Provide inbound customer support by answering incoming calls promptly and courteously.
Provide mentorship to less tenured examiners.
Provide oversight of external adjusters on outsourced claims.
Provide technical advice to Shared Services.
Provide testimony and deposition statements to participate in the litigation and discovery process.
Provide timely and effective communication of decisions to claimants and / or team.
Read
Read, analyze, understand, and ensure compliance with clients' customized plans.
Receive
Receive and evaluates information to determine cost of loss.
Recognize
Recognize when assistance is needed and obtains it.
Recommend
Recommend litigation by legal department when settlement cannot be negotiated.
Recommend litigation when appropriate.
Record
Record additional information / data into the companys network updating the electronic claim file.
Request
Request, review and analyze any physician notes, hospital records or police reports.
Request documentation from insurance representatives when no no-fault insurance exists.
Research
Research and respond to complex customer communications, concerns, conflicts or issues.
Respect
Respect individuals, the organization, authority, the community and the team.
Respond
Respond to complex arbitrations contentions.
Review
Review all documentation supporting the claim, proof of ownership, and parts and replacement costs.
Review and compile photos, secure statements and compile expert reports.
Review and interpret available coverage, recognizing policy exclusions, and applying facts of loss.
Review client records and evidence and identify key information.
Review damages and damage assessments and provide independent analysis.
Review, evaluates and submits potential underwriting referral actions.
Review file to identify complex and occasionally highly complex potential legal issues.
Review file to identify complex potential legal issues.
Review file to identify moderately complex potential legal issues.
Review Pended Claim Reports and close out pended claims for which no response has been received.
Review reports and participates in selecting the expert.
Review reports and selects the expert.
Review mitigation bills.
Revise
Revise case reserves in assigned claims files to cover probable costs.
Secure
Secure, preserve, and maintain evidence in a legal manner.
Seek
Seek assistance as needed.
Select
Select proper loss codes based on policy type.
Set
Set and maintain appropriate reserves to maximum authority level.
Set reserves within authority and recommends settlement values when loss exceeds authority.
Suggest
Suggest corrective action and preventive measures.
Summarize
Summarize documents and enter into claim system notes.
Take
Take loss reports directly from insureds and / or claimants and / or their representatives.
Take over assigned territory.
Take phone calls from both, dealers and customers.
Triage
Triage customer complaints and notifies Managers of any issues.
Understand
Understand auto repair and salvage programs (Mitchell / Audatex) for Auto position.
Understand building estimates (Xactimate / Symbility) for Property position.
Understand the importance of developing and maintaining cooperative relationships with others.
Understand the shop system, including ratings, labor rates and type of repairs.
Update
Update the claim file diary.
Upload
Upload photos and estimate and document file with notes regarding decision-making process.
Use
Use estimating software to produce accurate scopes of damage.
Use knowledge of third-party and tort liability.
Utilize
Utilize acceptable investigation claims handling and settlement techniques.
Utilize company vendor programs to assist in the accurate settlement of losses.
Validate
Validate information, including but not limited to invoices and receipts.
Verify
Verify accounts and issue payment on a timely basis.
Verify repair costs are performed within industry standards.
Work
Work multiple workstreams (Quick Foto Claims, Waivers, Virtual Assist, Tech Reviews, Total loss).
Write
Write reports and compose correspondence.
Most In-demand Hard Skills
The following list describes the most required technical skills of an Adjuster:
Estimating Software
Construction
Restoration
Insurance
Claims
MS Suite
Claims
Real Estate Appraisals
Bodily Injury Claims
Analysis of Comparative Information
Perform and Understand Advanced Numerical Calculations
Interpret Complex Documents of a Legal Nature
Valid Driver's License
Adjuster's License
Most In-demand Soft Skills
The following list describes the most required soft skills of an Adjuster:
Written and oral communication skills
Leadership
Organized
Multi-task in a fast-paced environment
Work independently with little direction
Communicative
Organizational capacity
Clear and professional communication
Interpersonal skills
Flexible
Compassionate
Analytical ability
Empathic
Self-starter
Time-management
Negotiation
Desire to make a difference through compassionate customer service
Friendly
Proactive
Draw valid conclusions
