Claims Adjusters, Examiners, and Investigators
13-1031.00

The occupation code you requested, 13-1031.01 (Claims Examiners, Property and Casualty Insurance), is no longer in use. In the future, please use 13-1031.00 (Claims Adjusters, Examiners, and Investigators) instead.

Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.

Sample of reported job titles: Claims Adjuster, Claims Analyst, Claims Examiner, Claims Representative, Claims Specialist, Corporate Claims Examiner, Field Claims Adjuster, General Adjuster, Home Office Claims Specialist, Litigation Claims Representative

Occupation-Specific Information

Tasks

  • Examine claims forms and other records to determine insurance coverage.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Pay and process claims within designated authority level.
  • Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Investigate and assess damage to property and create or review property damage estimates.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Confer with legal counsel on claims requiring litigation.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Collect evidence to support contested claims in court.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Present cases and participate in their discussion at claim committee meetings.
  • Report overpayments, underpayments, and other irregularities.
  • Attend mediations or trials.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Prepare reports to be submitted to company's data processing department.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.
  • Obtain credit information from banks and other credit services.
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.

back to top

Technology Skills

  • Access software — CCC EZNet electronic communications network; CSC Automated Work Distributor AWD
  • Analytical or scientific software — Injury Sciences EDR InSight; Insurance claims fraud detection software; Magnify Predictive Targeting System
  • Computer aided design CAD software — 4n6xprt Systems StiffCalcs; ARSoftware WinSMAC; PhotoModeler; Visual Statement Investigator Suite; 3 more
  • Data base reporting software — Corporate Systems ClaimsPro
  • Data base user interface and query software — Claims processing administration and management software; Fair Isaac Claims Advisor; Tropics Claims Reserve Management
  • Desktop publishing software — Microsoft Publisher
  • Document management software — Datanex ClaimTrac; Document management system software; Hyland OnBase Enterprise Content Management; InSystems Calligo Document Management System; 16 more
  • Electronic mail software — Microsoft Outlook In-Demand Hot technology
  • Enterprise resource planning ERP software — ADP software; CCC Pathways Appraisal Quality Solution
  • Expert system software — Axonwave Fraud and Abuse Management System; Bill review software; LexisNexis RiskWise; StrataCare StrataWare eReview; 8 more
  • Financial analysis software — Automatic Data Processing Estimating; CSC Colossus; Simsol for Adjusters; Turtle Creek Software Goldenseal Architect; 2 more
  • Information retrieval or search software — CGI-AMS BureauLink Enterprise
  • Interactive voice response software — Computerized voice stress analyzer CVSA software
  • Medical software — Healthcare common procedure coding system HCPCS; Medical condition coding software; Medical procedure coding software
  • Office suite software — Microsoft Office software In-Demand Hot technology
  • Presentation software — Microsoft PowerPoint In-Demand Hot technology
  • Spreadsheet software — Microsoft Excel In-Demand Hot technology
  • Word processing software — Microsoft Word In-Demand Hot technology
Hot technology
Hot Technologies are requirements most frequently included across all employer job postings.
In demand
In Demand skills are frequently included in employer job postings for this occupation.

back to top

Occupational Requirements

Work Activities

  • Working with Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
  • Communicating with People Outside the Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
  • Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
  • Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
  • Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
  • Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
  • Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
  • Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
  • Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
  • Analyzing Data or Information — Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
  • Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
  • Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
  • Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
  • Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
  • Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used.
  • Judging the Qualities of Objects, Services, or People — Assessing the value, importance, or quality of things or people.
  • Monitoring Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
  • Performing for or Working Directly with the Public — Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.
  • Estimating the Quantifiable Characteristics of Products, Events, or Information — Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.
  • Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
  • Developing and Building Teams — Encouraging and building mutual trust, respect, and cooperation among team members.
  • Scheduling Work and Activities — Scheduling events, programs, and activities, as well as the work of others.

back to top

Detailed Work Activities

back to top

Work Context

  • Electronic Mail — 100% responded “Every day.”
  • Telephone — 100% responded “Every day.”
  • Letters and Memos — 93% responded “Every day.”
  • Frequency of Decision Making — 93% responded “Every day.”
  • Contact With Others — 72% responded “Constant contact with others.”
  • Spend Time Sitting — 74% responded “Continually or almost continually.”
  • Importance of Being Exact or Accurate — 68% responded “Extremely important.”
  • Freedom to Make Decisions — 57% responded “A lot of freedom.”
  • Impact of Decisions on Co-workers or Company Results — 72% responded “Very important results.”
  • Importance of Repeating Same Tasks — 63% responded “Extremely important.”
  • Deal With External Customers — 76% responded “Extremely important.”
  • Time Pressure — 62% responded “Every day.”
  • Indoors, Environmentally Controlled — 79% responded “Every day.”
  • Structured versus Unstructured Work — 50% responded “Some freedom.”
  • Face-to-Face Discussions — 60% responded “Every day.”
  • Deal With Unpleasant or Angry People — 44% responded “Once a week or more but not every day.”
  • Frequency of Conflict Situations — 46% responded “Every day.”
  • Work With Work Group or Team — 38% responded “Extremely important.”
  • Duration of Typical Work Week — 44% responded “More than 40 hours.”
  • Spend Time Making Repetitive Motions — 34% responded “Continually or almost continually.”
  • Sounds, Noise Levels Are Distracting or Uncomfortable — 32% responded “Every day.”
  • Coordinate or Lead Others — 29% responded “Extremely important.”
  • Spend Time Using Your Hands to Handle, Control, or Feel Objects, Tools, or Controls — 42% responded “Continually or almost continually.”
  • Level of Competition — 46% responded “Moderately competitive.”
  • Degree of Automation — 41% responded “Moderately automated.”

back to top

Experience Requirements

Job Zone

Title
Job Zone Four: Considerable Preparation Needed
Education
Most of these occupations require a four-year bachelor's degree, but some do not.
Related Experience
A considerable amount of work-related skill, knowledge, or experience is needed for these occupations. For example, an accountant must complete four years of college and work for several years in accounting to be considered qualified.
Job Training
Employees in these occupations usually need several years of work-related experience, on-the-job training, and/or vocational training.
Job Zone Examples
Many of these occupations involve coordinating, supervising, managing, or training others. Examples include real estate brokers, sales managers, database administrators, graphic designers, conservation scientists, art directors, and cost estimators.
SVP Range
2-4 years of preparation (7.0 to < 8.0)

back to top

Training & Credentials

State training
Local training
Certifications
State licenses
Apprenticeships
Have a career path or location in mind? Visit Apprenticeship.gov external site to find apprenticeship opportunities near you.

back to top

Worker Requirements

Skills

  • Reading Comprehension — Understanding written sentences and paragraphs in work-related documents.
  • Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
  • Speaking — Talking to others to convey information effectively.
  • Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one.
  • Writing — Communicating effectively in writing as appropriate for the needs of the audience.
  • Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
  • Monitoring — Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
  • Social Perceptiveness — Being aware of others' reactions and understanding why they react as they do.
  • Active Learning — Understanding the implications of new information for both current and future problem-solving and decision-making.
  • Coordination — Adjusting actions in relation to others' actions.
  • Negotiation — Bringing others together and trying to reconcile differences.
  • Service Orientation — Actively looking for ways to help people.
  • Systems Analysis — Determining how a system should work and how changes in conditions, operations, and the environment will affect outcomes.
  • Time Management — Managing one's own time and the time of others.

back to top

Knowledge

  • Customer and Personal Service — Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
  • English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • Administrative — Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.
  • Mathematics — Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
  • Computers and Electronics — Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • Law and Government — Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
  • Administration and Management — Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
  • Economics and Accounting — Knowledge of economic and accounting principles and practices, the financial markets, banking, and the analysis and reporting of financial data.

back to top

Education

How much education does a new hire need to perform a job in this occupation? Respondents said:

  • 56%
     
    responded: Bachelor’s degree required
  • 13%
     
    responded: High school diploma or equivalent requiredmore info
  • 12%
     
    responded: Some college, no degree requiredmore info

back to top

Worker Characteristics

Abilities

  • Written Comprehension — The ability to read and understand information and ideas presented in writing.
  • Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences.
  • Oral Expression — The ability to communicate information and ideas in speaking so others will understand.
  • Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense.
  • Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
  • Near Vision — The ability to see details at close range (within a few feet of the observer).
  • Written Expression — The ability to communicate information and ideas in writing so others will understand.
  • Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
  • Speech Clarity — The ability to speak clearly so others can understand you.
  • Information Ordering — The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
  • Speech Recognition — The ability to identify and understand the speech of another person.
  • Category Flexibility — The ability to generate or use different sets of rules for combining or grouping things in different ways.
  • Flexibility of Closure — The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material.
  • Mathematical Reasoning — The ability to choose the right mathematical methods or formulas to solve a problem.
  • Number Facility — The ability to add, subtract, multiply, or divide quickly and correctly.
  • Perceptual Speed — The ability to quickly and accurately compare similarities and differences among sets of letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object.
  • Selective Attention — The ability to concentrate on a task over a period of time without being distracted.
  • Speed of Closure — The ability to quickly make sense of, combine, and organize information into meaningful patterns.

back to top

Interests

Interest code: CEI
Want to discover your interests? Take the O*NET Interest Profiler at My Next Move.
  • Conventional — Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
  • Enterprising — Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
  • Investigative — Investigative occupations frequently involve working with ideas, and require an extensive amount of thinking. These occupations can involve searching for facts and figuring out problems mentally.

back to top

Work Values

  • Support — Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
  • Independence — Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
  • Working Conditions — Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.

back to top

Work Styles

  • Integrity — Job requires being honest and ethical.
  • Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high-stress situations.
  • Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations.
  • Attention to Detail — Job requires being careful about detail and thorough in completing work tasks.
  • Initiative — Job requires a willingness to take on responsibilities and challenges.
  • Achievement/Effort — Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
  • Independence — Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
  • Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace.
  • Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
  • Persistence — Job requires persistence in the face of obstacles.
  • Self-Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
  • Concern for Others — Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
  • Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems.
  • Leadership — Job requires a willingness to lead, take charge, and offer opinions and direction.
  • Social Orientation — Job requires preferring to work with others rather than alone, and being personally connected with others on the job.
  • Innovation — Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems.

back to top

Workforce Characteristics

Wages & Employment Trends

Median wages (2021)
$31.29 hourly, $65,080 annual
State wages
Local wages
Employment (2021)
314,300 employees
Projected growth (2021-2031)
Decline (-2% or lower)
Projected job openings (2021-2031)
22,300
State trends
Top industries (2021)

Source: Bureau of Labor Statistics 2021 wage data external site and 2021-2031 employment projections external site. “Projected growth” represents the estimated change in total employment over the projections period (2021-2031). “Projected job openings” represent openings due to growth and replacement.

back to top

Job Openings on the Web

State job openings
Local job openings

back to top

More Information

back to top

Sources of Additional Information

back to top