Insurance Claims Adjuster Job Description
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:
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:
Desired experience for insurance claims adjuster includes:
Insurance Claims Adjuster Examples
Insurance Claims Adjuster Job Description
- 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
- 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
Insurance Claims Adjuster Job Description
- 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
- 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
Insurance Claims Adjuster Job Description
- 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
- 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
Insurance Claims Adjuster Job Description
- 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
- 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
Insurance Claims Adjuster Job Description
- 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
- 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