# 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.

- Code: 13-1031.00 (O*NET-SOC; SOC 2018 13-1031)
- Family: [Business & Financial](https://foundation.org.ai/occupations#family-13), one of its 50 occupations
- Tasks: 29 tasks (21 core, 6 supplemental and 2 not rated)
- Page: https://foundation.org.ai/occupations/13-1031.00
- JSON: https://foundation.org.ai/data/tasks/13-1031.00.json

## What the work is made of

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

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## Where this comes from

Quoted from O*NET 29.0, U.S. Department of Labor, Employment and Training Administration, under CC BY 4.0: free to copy and reuse, with credit. Nothing on this page is written by the Org.AI Foundation.
