理赔员

工作日程

• Claims Adjusters work standard 40-hour weeks but may have to work overtime during natural disasters or high-claim periods. The role may include both office and fieldwork, requiring travel to inspect damages firsthand.

典型职责

• Review claimants’ claims and policies to determine coverage terms and amounts
• Verify ownership of damaged or stolen property. Verify claimant employment records, when applicable
• Guide policyholders through the claims process
• Interview claimants and witnesses. Consult police and hospital records, as needed
• Inspect property damage or personal injury claims to determine the insurance company’s liability
• Work with contractors, repairers, and medical professionals to gather information on the extent of damages and cost estimates for repairs or treatments
• Correct any claim form errors or omissions
• Analyze findings and document investigative processes. Report findings and recommendations to the insurance company
• Negotiate settlements with claimants while representing the insurance company
• Issue or authorize payments to claimants, as applicable
• Maintain records of claims in computer systems. Report claim statuses to company management
• Collaborate with attorneys on claims requiring litigation or legal expertise. Gather and document evidence to support contested claims
• Represent insurance companies during trials or mediation
• Review legal billing to ensure cost-effective claims handling

额外责任

• Look for signs of insurance fraud via investigations and fraud detection techniques
• Refer claims requiring further investigation to special investigators or adjusters
• Identify and report financial discrepancies (such as overpayments or underpayments)
• Recommend adjustments to the company’s claims reserve (i.e., the funds set aside to pay future claims)
• Participate in committee meetings
• Stay informed about new insurance policies, legislation, and technologies
• Network with insurance professionals, attorneys, and industry partners

软技能

• 分析性思维
• 积极倾听
• 清晰的沟通
• 合规导向
• 解决冲突
• 批判性思维
• 客户服务
• 决策
• 注重细节
• 诚信
• 监测
• 谈判
• 解决问题
• 公共关系
• 团队合作
• 时间管理

技术技能

• Proficiency in interpreting insurance policies and coverage
• Understanding the principles of insurance claims handling and settlement
• Extensive knowledge of construction, automotive repair, or other relevant technical fields to assess damages accurately
• Familiarity with legal, medical, and repair cost terminology
• Use of claims management software and databases
• Knowledge of fraud detection techniques and practices

• Automotive repair shops and construction companies
• Government insurance services
• Independent claims adjusting firms
• 保险公司
• Legal firms specializing in insurance claims

When someone files an insurance claim, it’s usually because something bad, maybe even tragic, has happened in their lives. Claims Adjusters must be ready to handle emotionally charged situations with empathy and professionalism.

At the same time, they have to be objective and analytical when it comes to reviewing the claim and adhering to the insurance policy’s terms. Some claims may not pay out as the claimant would like. Certain cases may even have to be litigated to resolve them. Meanwhile, as many as 20% of claims could be considered fraudulent and must be investigated.

Claims Adjusters must be subject matter experts who are familiar with a wide range of claims-related topics, such as property damage estimates, average automotive repair costs, typical medical billing amounts, etc. They must also stay up-to-date with evolving insurance laws, policies, and technology.

Their workload can spike considerably after a large-scale accident or natural disaster. This can add significant pressure to work fast and accurately to resolve claims while claimants wait, often impatiently, to receive a payout for the losses they’ve suffered. 

New technologies are helping to streamline the claims process, making it faster and more efficient. That’s good news for Claims Adjusters, except for one thing—the increased efficiency is impacting job growth in this profession. Per the Bureau of Labor Statistics, overall employment in this field is projected to go down by 3% in the coming decade.

That said, environmental changes seem to be increasing the frequency of natural disasters which can lead to property damage and, in turn, insurance claims. Insurance companies obviously can’t afford to pay out more in claims than they earn from policy premiums (the amount paid to them every month to keep an insurance policy active). That’s why they operate using risk assessments that rely on predictions based on probability!

For example, the odds of Earth being hit by a big asteroid in any given year are about 1 in 500,000. Based on those odds, the probability of sustaining asteroid-related damage seems fairly low. An insurance company might reasonably predict that no large asteroids will hit this year, and thus be willing to provide coverage.

But when things become unpredictable or the odds of an event occurring become more probable, companies may be hesitant to offer coverage. In fact, Renewing America notes that a “2021 survey of insurance risk managers found that 60 percent feared climate change would make certain geographic areas uninsurable.” Because of these issues, insurers are using predictive analytics to anticipate future claims trends based on environmental changes.

Individuals drawn to a career as a Claims Adjuster might have enjoyed problem-solving activities or helping others in difficult situations. They may have also been intrigued by investigation processes and had a knack for detail-oriented tasks!