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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.

Tasks
29 tasks21 core, 6 supplemental, 2 not rated
Family
Business & FinancialOne of its 50 occupations
Code
13-1031.00SOC 2018: 13-1031

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What the work is made of

21 core tasks, 6 supplemental and 2 not rated, each quoted as published, with where it came from.

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Core: central to the jobSupplemental: done by some, not allNot rated: O*NET has not rated it core or supplemental

  1. Task 1. Examine claims forms and other records to determine insurance coverage.Core taskTask 21417Rated by 81 people who do the job, August 2022
  2. Task 2. Analyze information gathered by investigation and report findings and recommendations.Core taskTask 21418Rated by 81 people who do the job, August 2022
  3. Task 3. Pay and process claims within designated authority level.Core taskTask 21426Rated by 43 people who do the job, August 2022
  4. Task 4. 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.Core taskTask 21423Rated by 44 people who do the job, August 2022
  5. Task 5. 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.Core taskTask 21428Rated by 44 people who do the job, August 2022
  6. Task 6. Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.Core taskTask 21419Rated by 81 people who do the job, August 2022
  7. Task 7. Investigate and assess damage to property and create or review property damage estimates.Core taskTask 21420Rated by 80 people who do the job, August 2022
  8. Task 8. Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.Core taskTask 21421Rated by 81 people who do the job, August 2022
  9. Task 9. Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.Core taskTask 21422Rated by 79 people who do the job, August 2022
  10. Task 10. Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.Core taskTask 21429Rated by 44 people who do the job, August 2022
  11. Task 11. Resolve complex, severe exposure claims, using high service oriented file handling.Core taskTask 21425Rated by 44 people who do the job, August 2022
  12. Task 12. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.Core taskTask 21424Rated by 44 people who do the job, August 2022
  13. Task 13. Confer with legal counsel on claims requiring litigation.Core taskTask 21432Rated by 43 people who do the job, August 2022
  14. Task 14. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.Core taskTask 21427Rated by 44 people who do the job, August 2022
  15. Task 15. Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.Core taskTask 21434Rated by 44 people who do the job, August 2022
  16. Task 16. Refer questionable claims to investigator or claims adjuster for investigation or settlement.Core taskTask 21430Rated by 80 people who do the job, August 2022
  17. Task 17. Collect evidence to support contested claims in court.Core taskTask 21431Rated by 78 people who do the job, August 2022
  18. Task 18. Contact or interview claimants, doctors, medical specialists, or employers to get additional information.Core taskTask 21433Rated by 44 people who do the job, August 2022
  19. Task 19. Present cases and participate in their discussion at claim committee meetings.Core taskTask 21435Rated by 43 people who do the job, August 2022
  20. Task 20. Report overpayments, underpayments, and other irregularities.Core taskTask 21439Rated by 44 people who do the job, August 2022
  21. Task 21. Attend mediations or trials.Core taskTask 21443Rated by 43 people who do the job, August 2022
  22. Task 22. Supervise claims adjusters to ensure that adjusters have followed proper methods.Supplemental taskTask 21436Rated by 44 people who do the job, August 2022
  23. Task 23. Conduct detailed bill reviews to implement sound litigation management and expense control.Supplemental taskTask 21437Rated by 43 people who do the job, August 2022
  24. Task 24. Communicate with reinsurance brokers to obtain information necessary for processing claims.Supplemental taskTask 21440Rated by 44 people who do the job, August 2022
  25. Task 25. Prepare reports to be submitted to company's data processing department.Supplemental taskTask 21441Rated by 44 people who do the job, August 2022
  26. Task 26. Examine titles to property to determine validity and act as company agent in transactions with property owners.Supplemental taskTask 21438Rated by 78 people who do the job, August 2022
  27. Task 27. Obtain credit information from banks and other credit services.Supplemental taskTask 21442Rated by 81 people who do the job, August 2022
  28. Task 28. Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.Not ratedTask 21444Listed by O*NET analysts, November 2020
  29. Task 29. Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.Not ratedTask 21445Listed by O*NET analysts, November 2020

Where this comes from

Quoted from the U.S. Department of Labor, and credited. Nothing on this page is written by us.

How we copy and credit sources
  1. Published by
    O*NET 29.0, U.S. Department of LaborEmployment and Training Administration
  2. Classification
    Standard Occupational Classification 2018, 13-1031
  3. License
    CC BY 4.0Free to copy and reuse, with credit
  4. Changed by us
    Nothing.

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