The Role of The Insurance Company and Adjuster

The claims adjuster is responsible for representing the insurer in what is usually a highly stressful situation for the customer. Adjusters must be technical experts and organized to keep track of many details. They must also possess excellent customer service skills.

In the event of a loss, policyholders submit claims, or requests for payment, seeking compensation for their loss. Adjusters, appraisers, examiners, and investigators deal with those claims. They work primarily for property and casualty insurance companies, for whom they handle a wide variety of claims alleging property damage, liability, or bodily injury. Their main role is to investigate the claims, negotiate settlements, and authorize payments to claimants, all the while mindful not to violate the claimant's rights under Federal and State privacy laws. They must determine whether the customer's insurance policy covers the loss and how much of the loss should be paid to the claimant.

Adjusters investigate claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the company's liability. Adjusters may consult with other professionals, such as experts, lawyers, and physicians, who can offer a more professional evaluation of a claim. The information gathered-including photographs and statements, either written, audio, or on video tape-is set down in a report that is then used to evaluate the associated claim. When the policyholder's claim is legitimate, the claims adjuster negotiates with the claimant and settles the claim. When claims are contested, adjusters will work with attorneys and expert witnesses to defend the insurer's position.

Qualifications: Claims adjusters, appraisers, and examiners often work closely with claimants, witnesses, and other insurance professionals, so they must be able to communicate effectively with others. Knowledge of computer applications also is very helpful. In addition, a valid driver’s license and a good driving record are required for workers who must travel on the job. Some companies require applicants to pass a series of written aptitude tests designed to measure their communication, analytical, and general mathematical skills.

When hiring investigators, employers look for individuals who have ingenuity and who are persistent and assertive. Investigators should not be afraid of confrontation, should communicate well, and should be able to think on their feet. Good interviewing and interrogation skills also are important and usually are acquired in earlier careers in law enforcement.

Licensure: Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by State. Some States have few requirements, while others require either the completion of prelicensing education, a satisfactory score on a licensing exam, or both. Earning a voluntary professional designation can sometimes substitute for completing an exam. In some States, claims adjusters employed by insurance companies can work under the company license and need not become licensed themselves. Public adjusters may need to meet separate or additional requirements. For example, some States require public adjusters to file a surety bond. Some States that require licensing also require a certain number of continuing education credits per year in order to renew the license.