Claims Adjuster

Claims Adjuster

Claims adjustment involves investigating insurance claims and reconciling them against the claimant’s policy. Claims Adjusters determine the degree of the insurance company’s liability and what will be paid out on a claim to an insurance policy holder.

ROLE-AT-A-GLANCE
Binoculars
Demand Outlook
*

There is substantial opportunity and anticipated growth in claims adjustment into the future

Diploma
Education & Credentials
*

College/Undergraduate Degree Required.

Data chart
Quantitative Skills Required
*
Group of people
Interpersonal Skills & Relationship Management
*
Multiple devices Specialized Technology Skills
*
Desktop area Work Environment

Mobile/Varied. May involve field-work to assess situations and manage claims such as damage to a home or vehicle.

ROLE-AT-A-GLANCE
Binoculars
Demand Outlook
*

There is substantial opportunity and anticipated growth in claims adjustment into the future

Diploma
Education & Credentials
*

College/Undergraduate Degree Required.

Data chart
Quantitative Skills Required
*
Group of people
Interpersonal Skills & Relationship Management
*
Multiple devices Specialized Technology Skills *
Desktop area Work Environment

Mobile/Varied. May involve field-work to assess situations and manage claims such as damage to a home or vehicle.


WHAT IT IS

Key Role Dimensions

Assessing claims on insurance policies: Review claims for a specific type of insurance coverage (e.g. life, property, accident-benefit). Gather information on claims and reconcile it against the policy and either approve payment, escalate it for further review, or decline.

Working in a high-pressure environment: Typically work in a fast-paced environment to process high volumes of claims in a timely manner, with significant pressure to meet strict deadlines for claimants. In the case of natural disasters or severe weather events, claims can increase suddenly.

Working independently or in an insurance company: Claims Adjusters are either employees within insurance companies or work as independents, typically hired by smaller underwriters who outsource claims work.

Focus Areas

Claims Adjusters typically focus on developing expertise within a particular line of insurance (e.g. life, accident-benefit, property, commercial, specialized in factories, warehouses, etc.).


WHAT IT TAKES TO SUCCEED

Key Job Accountabilities

Claims Adjusters generally:

Reconcile claims against policy provisions:

  • Review details regarding a claim.
  • Review the policy in detail to determine what is covered.
  • Make recommendations and approve or adjust payment of benefits based on the policy.

Collect information required to substantiate claims:

  •  Meet with clients, discuss claims and identify needs.
  •  Gather necessary information by conducting field inspections where required.
  •  Assess the true value of the loss.

Maintain relationships with claimants, attorneys and subject matter experts:

  • Remain in contact on a regular basis and provide claim updates.

Knowledge, Skills & Experience

Must-haves:

  • Strong knowledge of policy coverage, limits of liability and reinsurance policies
  • Demonstrated ability in processing and/or reconciliation of information or data
  • Experience in investigative procedures and documentation
  • Strong Analytical Thinking: Problem-solving and reasoning skills
  • Communications skills (written and verbal) to communicate with the clients and others
  • Proven ability to be highly detail-oriented

 Nice-to-haves:

  • Previous experience in the insurance field
  • Previous exposure to claims (i.e., through Claims Assistant or other junior insurance roles)

Education & Credentials

Entry-level positions typically require:

  • College diploma or
  • Undergraduate university degree

In the fields of:

  • Business Administration
  • Engineering and Architecture
  • Health Sciences
  • General Arts in Psychology or Criminology
  • Skilled trade such as Automotive or Construction

Independent adjusters require an adjuster’s license, which can be obtained by completing the first four credits of the Chartered Insurance Professional (CIP) designation:


WHERE IT CAN TAKE YOU

Career Pathways

There are a number of pathways open to Claims Adjusters through:

  • Increased Seniority: If you wish to pursue managerial or supervisory opportunities, many organizations have a variety of leadership roles in claims adjustment.

  • Deeper Specialization: You may expand your knowledge in your field of claims adjustment and become an expert in the policies, liability limits and related legislation in that sector/area. You can also become a licensed Independent Claims Adjuster.

Future Trends & Impacts

There are several external factors that can influence the qualifications and demand for this role:

  • Line of Business: Varying levels of experience are required depending on the types of claims being reviewed.
  • Regulations: Claims Adjusters must keep up-to-date on any relevant legislation and/or regulatory changes.
  • Natural Disasters: World events such as natural disasters create acute spikes in claim volume.


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