Main Responsibilities and Required Skills for Claims Adjuster
A Claims Adjuster is a professional who investigates assigned claims and confirms coverage. They interact with clients to complete all investigations of claims. In this blog post we describe the primary responsibilities and the most in-demand hard and soft skills for Claims Adjusters.
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Main Responsibilities of Claims Adjuster
The following list describes the typical responsibilities of a Claims Adjuster:
Adjust
Adjust physical damage claims including unreported damage claims.
Analyze
Analyze complex information from different sources.
Annotate
Annotate and document your file in accordance with the company's standards and guidelines.
Anticipate
Anticipate recoveries and direct the investigation accordingly.
Apply
Apply basic communication skills to interpret callers inquiries and offers options.
Arrange
Arrange disposal of salvage arising from settled claims in accordance with departmental standards.
Assist in / Assist with
Assist in the development and implementation of training programs.
Assist with claims related phone calls and handle incoming correspondence.
Assist with various accounting functions as assigned.
Attend
Attend settlement meetings mediations, JDR's and trials as necessary on litigated claims.
Audit
Audit claims and create check request.
Build
Build and maintain relationships by providing timely and accurate service.
Carry out
Carry out other related tasks and projects as assigned.
Chase
Chase Recovery after the settlement of the Claim if required.
Close
Close collaboration with brokers and underwriting team.
Collaborate with
Collaborate with team members in a positive manner to quickly and effectively adjudicate claims.
Communicate
Communicate claim adjustments via written reports to all parties.
Communicate effectively with the repair facility and the policyholder.
Complete
Complete building inspections meeting OSHA guidelines.
Complete factual reports in a timely manner with company corporate standards and state regulations.
Complete field inspections.
Complete relevant education programs identified and paid for by the company.
Compose
Compose and type correspondence as required.
Conduct
Conduct a detailed review of the property and write an estimate to capture the extent of the damages.
Confirm
Confirm all facts to document the file as part of the overall investigation of claims.
Confirm claim resolution and amount of payment.
Consult
Consult police and hospital records.
Contribute to
Contribute to team effort by accomplishing related results as needed.
Coordinate
Coordinate medical, income, and other necessary assessments and reviews.
Coordinate subrogation process in claim files.
Correct
Correct information provided in the insurance application, if necessary, prior to claim payment.
Correspondence
Correspondence and independent adjusters as needed.
Create
Create and implement an action plan for the resolution for each file.
Create and maintain relationships with outside vendor partners specific to property claims.
Create an environment of continuous improvement.
Determine
Determine and timely sets appropriate reserves within authority level.
Determine priority of payments and assessment & calculation of benefit entitlements.
Determine the uninsured loss to the client and analyze the reasons for the uninsured loss.
Determine whether to accept ordeny a claim based on all documentation received.
Develop
Develop a claim action plan necessary to advance a claim towards settlement.
Develop and maintain effective relationships with external lawyers.
Discuss
Discuss findings of crop loss with farmers.
Document
Document claims through active listening and use of data to summarize liability decisions.
Ensure
Ensure all incoming digital documentation is responded to promptly and within required timelines.
Ensure all phone messages are responded to promptly and within company and regulatory timelines.
Ensure effective vendor management including expense management.
Ensure electronic submission of mail into HCAI system as needed.
Ensure prompt and equitable settlements in-line with Intact's policies, procedures and standards.
Ensure reserve adequacy throughout the life of the claim file as per company guidelines.
Ensure Service Delivery Partners are working within prescribed standards.
Ensure that all allocated work is handled within the Key Performance Targets of the Department.
Ensure that staff development plans are in place with feedback and follow up.
Ensure the accurate and efficient payment of claims.
Ensure the accurate and efficient payment of claims as well as accurate and timely reports.
Ensure the quality of work of others.
Enter
Enter estimates into the computer.
Evaluate
Evaluate all information to determine how claim should be handled.
Evaluate and conclude office handled claims.
Evaluate and handle claim payments and resolution of claims without payments.
Evaluate and settle assigned claims based upon the results of the investigation.
Evaluate financial impact to AIG under various policy scenarios (e.g. primary.
Evaluate, setting and recommending reserves.
Evaluate the performance of others.
Excess
Excess and primary coverage.
File
File Documentation and Reporting.
Follow
Follow third-party inspection guidelines and processes as defined by the company.
Follow up
Follow up with third parties to move subrogation files to successful recovery closure.
Foster
Foster good relationships with internal and external customers and drive excellent customer service.
Gather
Gather and examine photographs, statements, and evidence of damages / personal injuries.
Gather facts in order to determine liability and coverage.
Give
Give clarity and focus to deliver business results.
Handle
Handle all kind of Complex losses within authority limits.
Handle and process personal injury and various claims.
Handle Auto Personal Injury Protection (PIP) claims.
Handle claims on a good faith basis.
Handle phone calls and emails professionally.
Hire
Hire and manage defense and coverage counsel, and any other external resources.
Identify
Identify claims with potential recovery.
Identify subrogation opportunities and fraud potential and make appropriate.
Identify third parties who may have potential civil liability claims against the insured.
Implement
Implement and organize strategy for managing pending of ongoing files.
Inform
Inform manager if claim exceeds authority limits, making recommendations where appropriate.
Inspect
Inspect, scope, approve, and adjust estimates of damage, as well as determines loss amounts.
Interact with
Interact with attorneys and present case synopsis when required.
Interact with insurance carriers and healthcare providers to secure records and account balances.
Interact with legal representatives or rehab consultant in order to move claim forward.
Interface with
Interface with customers, agents, dealers to complete all investigations of claims.
Interpret
Interpret policy contacts and identify how coverage applies to a particular loss.
Interpret reports in order to draw accurate conclusions about proposed treatment and / or actions.
Interview
Interview customers, taking initial reports of claims and collecting all pertinent loss information.
Investigate
Investigate and Adjust Claims.
Investigate and negotiate property claims in accordance with claim procedures and guidelines.
Investigate and process insurance claims filed by policyholders.
Investigate assigned claims – confirm coverage – verify damages-determine liability.
Investigate, evaluate, and negotiate liability claims to ensure a positive customer experience.
Investigate, evaluate and settle entry-level insurance claims.
Investigate motor vehicle accident physical damage claims.
Investigate, negotiate and settle claims.
Keep
Keep insured / claimant / broker fully informed of the status of the claim.
Keep up to date on Intact's Prestige products, appraisal and investigation techniques and services.
Learn
Learn and comply with Company claim handling procedures.
Liaise with
Liaise with Finance Department and Dealer Support Team, as necessary.
Maintain
Maintain and controls additional living expense exposure.
Maintain a professional demeanor and image in accordance with Company policies and expectations.
Maintain a professional working relationship with the insured.
Maintain a valid claims adjuster license in all states that require a license.
Maintain confidentiality and data security.
Maintain control over expenses through pro-active handling techniques.
Maintain cost control over claims expenses.
Maintain expected case load.
Maintain professional and technical knowledge through continuing education.
Maintain punctual attendance in accordance with assigned work schedule.
Make
Make initial contact as per account guidelines.
Make and maintains a connection with the customer by understanding and meeting their needs.
Make independent decisions and self-supervises most files but recognizes when assistance is needed.
Manage
Manage and handle all administrative aspects of claim files.
Manage claims in litigation, participate in mediations, pre-trials and settlement conferences.
Manage diaries and tasks in the Claims System.
Manage phone calls and e-mails in a fast-paced environment.
Meet
Meet established benchmark measures for claims volume, quality and response times.
Mentor
Mentor and train less experienced claims and support staff as required.
Monitor
Monitor customer service queues (phone and email).
Negotiate
Negotiate and resolve claims effectively and efficiently.
Negotiate and settle claims pro-actively in accordance with Company guidelines and best practices.
Negotiate claim settlements with customers in accordance with business unit standard methodologies.
Negotiate complaints with third parties efficiently, if appropriate.
Negotiate fair and satisfactory settlements.
Negotiate prices for labour and parts.
Negotiate repair process with body shops.
Negotiate settlements with claimants and claimant's attorneys.
Negotiate settlements with customers and / or representatives.
Negotiate with claimant to settle claim.
Obtain
Obtain and validate documentation that confirms that a submitted claim is eligible for payment.
Order
Order police reports, set-up new claim files, confirmation of loss to insurer & broker.
Participate in
Participate hands-on in the resolution of complex claims and coverage issues.
Participate in case law reviews.
Participate in claims dispute resolution process as required.
Participate in Friday afternoon nerf gun wars.
Performance
Performance delivered by KPI's.
Perform
Perform disaster claim duty as necessary.
Perform other tasks and duties as assigned by the Manager.
Prepare
Prepare comprehensive demands and assemble support for submission to carriers.
Prepare estimates of damage or loss where required.
Prepare reports for internal and external parties.
Present
Present evidence at legal proceedings, producing products and other documents as evidence.
Process
Process all payments promptly within guidelines and policy / statutory requirements.
Process file accounts and expenses for payment and submits for approval where required.
Process medical bills and recognizes medical management opportunities.
Process payments in accordance with BCAA best practices.
Provide
Provide a high standard of customer service and adherence to legal and regulatory requirements.
Provide consistent technical claims training to the team to ensure consistency.
Provide excellent customer service to internal and external clients.
Provide inbound customer support by answering incoming calls promptly and courteously.
Provide industry-leading customer service to insureds and brokers.
Provide mentorship to less tenured adjusters.
Provide ongoing status updates to customers until file closure.
Provide oversight of external adjusters on outsourced claims.
Receive
Receive and evaluates information to determine cost of loss.
Receive and handle all claims which fall under the Medical Only category.
Recognize
Recognize the need for and obtains non-waiver as needed.
Recognize the need for and sends Reservation of Rights letters.
Recognize when assistance is needed and obtains it.
Recognize when to secure public documents to complete a claim file investigation.
Record
Record data and statements in report.
Report
Report key claims information to Aerospace senior management and to internal stakeholders.
Represent
Represent AIG claims expertise on external technical panels and / or industry forums.
Research
Research state laws and medical terms.
Resolve
Resolve internal and external customer inquiries.
Resolve any issues noted.
Respond to
Respond to customer inquiries, makes appropriate decisions and closes file as needed.
Respond to email and phone correspondence per department guidelines.
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 determine validity of any supplement requests.
Review and interpret available coverage, recognizing policy exclusions, and applying facts of loss.
Review investigation notes and determine claim value, coverage and liability for basic claims.
Scope
Scope and establish quantum of damages.
Seek
Seek assistance as needed.
Select
Select proper loss codes based on policy type.
Study
Study insurance policies, endorsements, and forms to develop foundational product knowledge.
Support
Support attorneys to defend the insurance carrier in case of litigation.
Support the preparation and compilation of monthly statistical reports.
Take
Take loss reports directly from insureds and / or claimants and / or their representatives.
Take phone calls from both, dealers and customers.
Take recorded statements from claimants, insured's, witnesses, etc. and prepares summaries.
Take recorded statements from relevant parties, as needed.
Track
Track compliance items including invoicing using the OAB system.
Travel
Travel, attend seminars and attend other training classes as required.
Treat
Treat each customer encounter with best in class customer service.
Understand
Understand and promote IT innovation and integration.
Understand the importance of developing and maintaining cooperative relationships with others.
Uphold
Uphold Service Level Agreements and best practice standards.
Use
Use active listening and questioning skills to understand issues and needs.
Use knowledge of third party and tort liability.
Utilize
Utilize acceptable investigation claims handling and settlement techniques that.
Utilize arbitration, appraisal and alternate dispute resolution as needed.
Utilize company Claim Bulletins, manuals and best practices.
Validate
Validate information, including but not limited to invoices and receipts.
Verify
Verify claims are processed following the policy and procedure established by Smart Autocare.
Verify repair costs are performed within industry standards.
Verify repair information to determine if coverage was within the limits of the service contract.
Work with
Work directly with multiple coworkers involved in the management and support of case files.
Work within defined limits and authority on assignments of minimal complexity.
Write
Write reports and compose correspondence.
Most In-demand Hard Skills
The following list describes the most required technical skills of a Claims Adjuster:
CL - Claims
Insurance
MS Office
Policy Wordings
Crop Insurance Regulations
Read Maps
Claims Settlement
Consistent Policy Interpretation
Insurance Contracts
Analysis of Comparative Information
Bodily Injury Claims
Most In-demand Soft Skills
The following list describes the most required soft skills of a Claims Adjuster:
Written and oral communication skills
Interpersonal skills
Negotiation
Analytical ability
Organizational capacity
Time-management
Problem-solving attitude
Bilingualism
Attention to detail
Leadership
Decision-making skills
Work independently with little direction
Work with minimum supervision
Investigative
Empathy
Organized
Patience
Gain support and influence others
Gain trust
Make decisions
Sound judgment
Take initiative
Work within tight deadlines
Work effectively under pressure
Team player
Positive attitude
