Claims adjusters, examiners, and investigators 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.
Examine claims forms and other records to determine insurance coverage.
Analyze information gathered by investigation and report findings and recommendations.
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.
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.
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
Resolve complex, severe exposure claims, using high service oriented file handling.
Pay and process claims within designated authority level.
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
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.
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
Refer questionable claims to investigator or claims adjuster for investigation or settlement.
Collect evidence to support contested claims in court.
Confer with legal counsel on claims requiring litigation.
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
Present cases and participate in their discussion at claim committee meetings.
Supervise claims adjusters to ensure that adjusters have followed proper methods.
Conduct detailed bill reviews to implement sound litigation management and expense control.
Examine titles to property to determine validity and act as company agent in transactions with property owners.
Report overpayments, underpayments, and other irregularities.
Communicate with reinsurance brokers to obtain information necessary for processing claims.
Prepare reports to be submitted to company's data processing department.
Obtain credit information from banks and other credit services.
Attend mediations or trials.
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.
Work Context
Telephone —
Electronic Mail —
Letters and Memos —
Frequency of Decision Making —
Contact With Others —
Importance of Being Exact or Accurate —
Impact of Decisions on Co-workers or Company Results —
Spend Time Sitting —
Indoors, Environmentally Controlled —
Freedom to Make Decisions —
Deal With External Customers —
Importance of Repeating Same Tasks —
Time Pressure —
Face-to-Face Discussions —
Frequency of Conflict Situations —
Structured versus Unstructured Work —
Work With Work Group or Team —
Deal With Unpleasant or Angry People —
Spend Time Making Repetitive Motions —
Degree of Automation —
Level of Competition —
Sounds, Noise Levels Are Distracting or Uncomfortable —
Interacting With Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
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.
Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
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.
Communicating with Persons Outside 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.
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.
Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
Monitor Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used.
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.
Judging the Qualities of Things, Services, or People — Assessing the value, importance, or quality of things or people.
Thinking Creatively — Developing, designing, or creating new applications, ideas, relationships, systems, or products, including artistic contributions.
Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
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.
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.
Law and Government
Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.
Clerical
Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
Mathematics
Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
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.
Understanding written sentences and paragraphs in work related documents.
Critical Thinking
Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
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.
Speaking
Talking to others to convey information effectively.
Writing
Communicating effectively in writing as appropriate for the needs of the audience.
Negotiation
Bringing others together and trying to reconcile differences.
Active Learning
Understanding the implications of new information for both current and future problem-solving and decision-making.
Judgment and Decision Making
Considering the relative costs and benefits of potential actions to choose the most appropriate one.
Complex Problem Solving
Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Social Perceptiveness
Being aware of others' reactions and understanding why they react as they do.
Monitoring
Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
Service Orientation
Actively looking for ways to help people.
Coordination
Adjusting actions in relation to others' actions.
Persuasion
Persuading others to change their minds or behavior.
The ability to listen to and understand information and ideas presented through spoken words and sentences.
Written Comprehension
The ability to read and understand information and ideas presented in writing.
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).
Speech Clarity
The ability to speak clearly so others can understand you.
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 there is a problem.
Written Expression
The ability to communicate information and ideas in writing so others will understand.
Near Vision
The ability to see details at close range (within a few feet of the observer).
Speech Recognition
The ability to identify and understand the speech of another person.
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).
Category Flexibility
The ability to generate or use different sets of rules for combining or grouping things in different ways.
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.
