A Claims Adjuster investigates, evaluates, and settles insurance claims, ensuring fair and timely resolution for both policyholders and insurers. This role is vital for maintaining customer trust, controlling claim costs, and protecting the company's financial integrity.
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What is a Claims Adjuster?
A Claims Adjuster is a professional responsible for handling insurance claims from start to finish. They work for insurance companies or as independent adjusters, serving as the primary point of contact for policyholders during the claims process. Their expertise lies in investigating the validity of claims, determining coverage, and negotiating settlements in accordance with policy terms and legal regulations.
What does a Claims Adjuster do?
A Claims Adjuster conducts thorough investigations by reviewing documents, interviewing claimants and witnesses, and inspecting property damage or injuries. They analyze policy coverage to determine what is applicable under the claim, calculate settlement amounts based on evidence and estimates, and negotiate with claimants or their representatives to reach fair agreements. Additionally, they document all activities, maintain accurate records, and ensure compliance with state and federal laws to mitigate fraud and uphold company standards.
Job Overview
A Claims Adjuster is responsible for investigating, evaluating, and settling insurance claims. This role involves examining property damage, determining coverage, negotiating settlements, and ensuring compliance with company policies and state regulations. The ideal candidate will possess strong analytical skills, attention to detail, and excellent communication abilities to handle claims efficiently and fairly.
Claims Adjuster responsibilities include:
1. Investigate insurance claims by interviewing claimants, witnesses, and reviewing relevant documents.
2. Inspect property damage, assess loss, and determine coverage based on policy terms.
3. Evaluate claim validity and negotiate settlements with claimants or their representatives.
4. Document all claim activities, including findings, decisions, and payments, in the claims management system.
5. Collaborate with legal counsel, appraisers, and other professionals to resolve complex claims.
6. Ensure compliance with state regulations, company policies, and industry standards.
7. Communicate claim status and decisions to policyholders, agents, and other stakeholders.
8. Identify potential fraud indicators and escalate suspicious claims for further investigation.
1. High school diploma or equivalent; some college coursework in business or related field preferred.
2. Minimum 2 years of experience in claims adjusting or insurance industry role.
3. Valid state-issued adjuster license (or ability to obtain within 90 days of hire).
4. Proficiency with claims management software and Microsoft Office Suite.
5. Strong knowledge of insurance policies, coverage terms, and state regulations.
6. Excellent negotiation, communication, and customer service skills.
7. Ability to handle multiple claims simultaneously while meeting deadlines.
8. Detail-oriented with strong analytical and problem-solving abilities.
Preferred Qualifications
1. Bachelor's degree in Business, Finance, or related field.
2. 3+ years of experience as a Claims Adjuster with proven settlement track record.
3. Professional certifications such as AIC (Associate in Claims) or CPCU (Chartered Property Casualty Underwriter).
4. Experience with Xactimate or similar estimating software for property claims.
5. Background in handling both property and casualty claims.
6. Bilingual skills (Spanish/English) for diverse customer interactions.
7. Knowledge of medical terminology for injury claims handling.
8. Experience working with independent adjuster firms or multiple insurance carriers.
Bonus Skills
1. Advanced Xactimate certification and proficiency with Sketch functionality.
2. Experience with catastrophe claims handling and deployment readiness.
3. Knowledge of construction methods, materials, and repair processes.
4. Familiarity with ISO ClaimSearch or similar fraud detection systems.
5. Technical expertise in specific claim types (e.g., commercial property, workers' compensation).
6. Strong network of contractor and vendor relationships for claim repairs.
7. Experience mentoring or training junior adjusters.
8. Active participation in industry associations (e.g., NAII, PCI).
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