INSURANCE ADJUSTERS, EXAMINERS AND INVESTIGATORS California Occupational Guide Number 67 Interest Area 11 1997
THE JOB
Insurance guards against financial loss from injury, illness, death, property damage, or liability for harm or loss to other people. When a claim for a loss is submitted, INSURANCE ADJUSTERS, EXAMINERS AND INVESTIGATORS judge the facts and write up the settlements.
When insurance companies get a claim, they find out whether the loss is covered by the terms of the policy and whether the policy is still valid. If so, they check out the truth of the claim, the value of the loss, and the amount the company will pay.
Property and liability representatives are generally known as Insurance Adjusters or Claims Adjusters, and they read police reports and medical records, get diagrams and photos of the scene of the loss, talk with lawyers, and take statements from claimants and witnesses. They may inspect damaged property and estimate the cost of repair or replacement, or they may get an outside appraisal. Depending on how their investigation turns out, adjusters accept the claim, deny it, or try to negotiate a settlement. Adjusters have to protect the company from false or inflated claims but also have to settle valid claims fairly and quickly. Adjusters usually have the authority to make settlements up to a specific amount. Settlements above this amount need a supervisor's O.K.
Some Insurance Adjusters specialize in one type of claim, such as property, liability, or workers' compensation; others handle all claims on multi- coverage policies. In many companies, inside or office adjusters deal with claims that can be settled by phone and mail; outside or field adjusters handle those claims which need on-site inspection.
Representatives of life, medical and disability insurance companies are called Claims Examiners. Most benefits are paid routinely and with no delay if claim forms and the necessary documents, such as the hospital records or death certificates, are in order. In some circumstances, such as accidental death or long-term disability, Examiners may contact claimants, doctors or employers for more information. Because long-term disability cases need review, some companies use their own field disability claims representatives for this purpose. Others use outside investigating services. Once the claim is found valid, Examiners work out and authorize the payment.
WORKING CONDITIONS
Claims Examiners work in the company headquarters, usually located in a big city. Claims Adjusters most often work in smaller branch offices. Most offices are modern, well-lit and equipped with the latest office machines and computers. Field Adjusters are out of the office a lot and may get less direct supervision. A lot of driving is required, but there's very little over-night travel. Report writing is a big part of the job, and Field Adjusters can spend up to two days a week in the office working on reports.
Adjusters may belong to local and national claims associations. Not many Insurance Adjusters, Examiners and Investigators are members of unions.
EMPLOYMENT OUTLOOK
The California Projections of Employment, published by the Labor Market Information Division of the Employment Development Department, estimates that the number of Insurance Adjusters, Examiners and Investigators in California will reach 23,980 by 2005, an increase in new jobs of 7,570 over the number there was in 1993.
There will also be an estimated 2,790 job openings due to people retiring or leaving the occupation. Added to the 7,570 new jobs expected, this makes for an estimated total of 10,360 job opportunities through 2005.
(These figures do not include self-employment nor openings due to turnover.)
Computers make it possible for claims representatives to handle more work efficiently, but California, on top of having more sales than other states, also has more complex legal claims filed. These two things offset extra productivity somewhat. This trend is expected to continue for the next few years. An exception may exist in the casualty insurance area such as car insurance.
WAGES, HOURS AND FRINGE BENEFITS
Starting salaries for Insurance Adjusters, Examiners and Investigators go from $7.50 to $15.00 an hour. Experienced workers can earn from $10.00 to $22.00 per hour. Fully experienced can make between $11.50 and $25.00 an hour. The difference in wages seems to depend on where the job is and how complex it is.
A normal work week is 37-40 hours, Monday through Friday, with overtime once in a while. Field Adjusters set their own schedules. They often work nights or weekends to talk to witnesses or claimants.
Fringe benefits may include paid vacations, holidays and sick leave, profit- sharing, bonuses, commissions, group life and health insurance, pension plans and paid education. Field Adjusters get an expense account and use of a company car or mileage.
ENTRANCE REQUIREMENTS AND TRAINING
Many employers require a bachelor's degree for this job. Some do not ask for a degree, but they do prefer those who have degrees in business administration or liberal arts.
Some employers will hire someone as a clerical and after two or three years of work related to claims, will let them transfer to the job of Insurance Claims Representative trainee. They expect the trainee to have very good clerical skills and knowledge of medical terms, data processing, and good communication skills. Paralegal, investigative, or business experience and knowledge of car repair or construction are also helpful. A driver's license and a good driving record are required for Field Adjusters.
Those interested in life and disability Claims Examiner jobs should take courses in physiology, anatomy, medical terms, and data processing. Basic math skills with fractions, decimals and percentages are a must. Data entry or medically related work experience (such as a job in a doctor's office or hospital) is desirable.
Insurance courses and some degree programs are given by colleges and business schools, but most big insurance companies have their own training programs to teach beginners the basic job skills. Correspondence courses in insurance are often available and may be paid for by the company.
Adjusters, Examiners, and Investigators must be analytical but able to deal with people in stressful situations. Good communication skills, sharp observation, careful attention to details, and good judgment are a must. Field work requires walking, climbing stairs, and working outdoors (sometimes in bad weather) for long hours.
ADVANCEMENT
Insurance Adjusters, Examiners and Investigators with several years of experience may get to manager jobs. Experienced Adjusters sometimes establish themselves as independent Adjusters who contract with insurance companies to settle claims for them. Others become public Adjusters who represent the claimant. Both must be licensed by the State of California, Department of Insurance.
FINDING THE JOB
Many companies recruit on college campuses. The California Employment Development Department Job Service, employment agencies, classified ads and personal contacts may provide referrals or leads. Applying directly to employers is also recommended. Trainee openings are usually posted in insurance company offices; anyone qualified may apply.
ADDITIONAL SOURCES OF INFORMATION
Insurance Information Institute 110 William Street New York, NY 10038 (212) 669-9200
State Department of Insurance 320 Capitol Mall Sacramento, CA 95814 (916) 322-3555
RELATED OCCUPATIONAL GUIDES
Actuaries No. 318 Insurance Sales Agents No. 455
OCCUPATIONAL CODE REFERENCES
DOT (Dictionary of Occupational Titles, 4th ed., Rev. 1) Claim Adjuster (insurance) 241.217-010 Claim Examiner (insurance) 241.267-018
OES (Occupational Employment Statistics) System Insurance Adjusters, Examiners & Investigators 533020
Source: State of California, Employment Development Department,
Labor Market Information Division, Information Services Group,
(916) 262-2162.
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