ResumeShip
13-1031.00Apprenticeship

Claims Adjusters, Examiners, & 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.

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Key Tasks

  • Examine claims forms and other records to determine insurance coverage.
  • Analyze information gathered by investigation and report findings and recommendations.
  • Pay and process claims within designated authority level.
  • 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.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • 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.
  • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
  • Investigate and assess damage to property and create or review property damage estimates.
  • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Resolve complex, severe exposure claims, using high service oriented file handling.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
  • Confer with legal counsel on claims requiring litigation.
  • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
  • Collect evidence to support contested claims in court.
  • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
  • Supervise claims adjusters to ensure that adjusters have followed proper methods.
  • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
  • Conduct detailed bill reviews to implement sound litigation management and expense control.
  • Communicate with reinsurance brokers to obtain information necessary for processing claims.
  • Present cases and participate in their discussion at claim committee meetings.
  • Report overpayments, underpayments, and other irregularities.
  • Prepare reports to be submitted to company's data processing department.
  • Attend mediations or trials.
  • Examine titles to property to determine validity and act as company agent in transactions with property owners.
  • Obtain credit information from banks and other credit services.
  • Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.
  • Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.

Skills

Reading Comprehension
78%
Active Listening
75%
Critical Thinking
75%
Speaking
72%
Judgment and Decision Making
69%
Writing
66%
Complex Problem Solving
63%
Social Perceptiveness
60%
Monitoring
60%
Active Learning
56%
Coordination
56%
Service Orientation
53%
Negotiation
53%
Time Management
50%
Systems Analysis
50%
Mathematics
47%
Persuasion
47%
Systems Evaluation
47%
Management of Personnel Resources
44%
Quality Control Analysis
41%
Instructing
38%
Learning Strategies
38%
Programming
28%
Management of Financial Resources
28%
Operations Monitoring
22%
Management of Material Resources
19%
Technology Design
19%
Troubleshooting
16%
Operations Analysis
13%
Science
10%
Operation and Control
3%
Equipment Selection
3%
Repairing
0%
Installation
0%
Equipment Maintenance
0%

Knowledge

Customer and Personal Service
93%
English Language
86%
Administrative
71%
Mathematics
67%
Computers and Electronics
61%
Law and Government
58%
Administration and Management
52%
Economics and Accounting
51%
Education and Training
48%
Psychology
47%
Communications and Media
43%
Medicine and Dentistry
43%
Therapy and Counseling
40%
Personnel and Human Resources
36%
Telecommunications
33%
Public Safety and Security
32%
Building and Construction
28%
Sales and Marketing
27%
Production and Processing
27%
Transportation
26%
Sociology and Anthropology
23%
Mechanical
22%
Biology
22%
Foreign Language
21%
Geography
21%
Engineering and Technology
19%
Philosophy and Theology
14%
Chemistry
14%
Physics
14%
Design
10%
History and Archeology
8%
Fine Arts
4%
Food Production
1%

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Abilities

Written Comprehension
85%
Oral Expression
78%
Oral Comprehension
78%
Deductive Reasoning
75%
Inductive Reasoning
75%
Near Vision
72%
Written Expression
72%
Speech Clarity
66%
Problem Sensitivity
66%
Speech Recognition
63%
Information Ordering
63%
Category Flexibility
60%
Flexibility of Closure
56%
Perceptual Speed
50%
Number Facility
50%
Mathematical Reasoning
50%
Speed of Closure
50%
Selective Attention
50%
Far Vision
47%
Fluency of Ideas
44%
Memorization
41%
Time Sharing
41%
Originality
41%
Visualization
38%
Auditory Attention
35%
Trunk Strength
35%
Visual Color Discrimination
28%
Wrist-Finger Speed
25%
Hearing Sensitivity
22%
Arm-Hand Steadiness
19%
Finger Dexterity
19%
Manual Dexterity
19%
Depth Perception
13%
Dynamic Strength
13%
Control Precision
13%
Spatial Orientation
10%
Speed of Limb Movement
3%
Sound Localization
0%
Reaction Time
0%
Extent Flexibility
0%
Night Vision
0%
Stamina
0%
Static Strength
0%
Peripheral Vision
0%
Explosive Strength
0%
Multilimb Coordination
0%
Gross Body Equilibrium
0%
Glare Sensitivity
0%
Rate Control
0%
Dynamic Flexibility
0%
Response Orientation
0%
Gross Body Coordination
0%

Work Activities

Working with Computers
92%
Communicating with People Outside the Organization
90%
Getting Information
89%
Identifying Objects, Actions, and Events
87%
Making Decisions and Solving Problems
87%
Communicating with Supervisors, Peers, or Subordinates
85%
Documenting/Recording Information
84%
Resolving Conflicts and Negotiating with Others
82%
Organizing, Planning, and Prioritizing Work
81%
Analyzing Data or Information
77%
Processing Information
76%
Establishing and Maintaining Interpersonal Relationships
75%
Updating and Using Relevant Knowledge
75%
Evaluating Information to Determine Compliance with Standards
71%
Interpreting the Meaning of Information for Others
69%
Performing for or Working Directly with the Public
64%
Judging the Qualities of Objects, Services, or People
64%
Monitoring Processes, Materials, or Surroundings
64%
Estimating the Quantifiable Characteristics of Products, Events, or Information
58%
Performing Administrative Activities
55%
Scheduling Work and Activities
51%
Developing and Building Teams
51%
Thinking Creatively
48%
Assisting and Caring for Others
48%
Developing Objectives and Strategies
47%
Monitoring and Controlling Resources
44%
Training and Teaching Others
44%
Inspecting Equipment, Structures, or Materials
43%
Coordinating the Work and Activities of Others
38%
Providing Consultation and Advice to Others
37%
Selling or Influencing Others
35%
Coaching and Developing Others
33%
Guiding, Directing, and Motivating Subordinates
29%
Staffing Organizational Units
26%
Operating Vehicles, Mechanized Devices, or Equipment
25%
Performing General Physical Activities
18%
Handling and Moving Objects
14%
Controlling Machines and Processes
13%
Drafting, Laying Out, and Specifying Technical Devices, Parts, and Equipment
9%
Repairing and Maintaining Mechanical Equipment
4%
Repairing and Maintaining Electronic Equipment
4%

Work Context

E-Mail

How frequently does your job require you to use E-mail?

100%

Telephone Conversations

How often do you have telephone conversations in this job?

100%

Written Letters and Memos

How frequently does your job require written letters and memos?

98%

Frequency of Decision Making

How often is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?

97%

Contact With Others

How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?

92%

Spend Time Sitting

How much does this job require sitting?

91%

Importance of Being Exact or Accurate

How important is being very exact or highly accurate in performing this job?

90%

Freedom to Make Decisions

How much decision making freedom, without supervision, does the job offer?

88%

Impact of Decisions on Co-workers or Company Results

What results do your decisions usually have on other people or the image or reputation or financial resources of your employer?

88%

Importance of Repeating Same Tasks

How important are continuous, repetitive, physical activities (like key entry) or mental activities (like checking entries in a ledger) to performing this job?

88%

Deal With External Customers or the Public in General

How important is it to deal with external customers (as in retail sales) or the public in general (as in police work) in this job?

86%

Time Pressure

How often does this job require the worker to meet strict deadlines?

85%

Determine Tasks, Priorities and Goals

How much freedom does the worker have in determining the tasks, priorities, or goals of the job?

83%

Indoors, Environmentally Controlled

How often does this job require working indoors in an environmentally controlled environment (like a warehouse with air conditioning)?

83%

Face-to-Face Discussions with Individuals and Within Teams

How frequently does your job require face-to-face discussions with individuals and within teams?

82%

Dealing With Unpleasant, Angry, or Discourteous People

How frequently does the worker have to deal with unpleasant, angry, or discourteous individuals as part of the job requirements?

78%

Conflict Situations

How frequently are there conflict situations the employee has to face in this job?

76%

Work With or Contribute to a Work Group or Team

How important is it to work with or contribute to a work group or team in this job?

72%

Duration of Typical Work Week

Number of hours typically worked in one week.

59%

Spend Time Making Repetitive Motions

How much does this job require making repetitive motions?

58%

Exposed to Sounds, Noise Levels that are Distracting or Uncomfortable

How often does this job require working exposed to sounds and noise levels that are distracting or uncomfortable?

56%

Coordinate or Lead Others in Accomplishing Work Activities

How important is it to coordinate or lead others (not as a supervisor or team leader) in accomplishing work activities in this job?

55%

Spend Time Using Your Hands to Handle, Control, or Feel Objects, Tools, or Controls

How much does this job require using your hands to handle, control, or feel objects, tools or controls?

55%

Level of Competition

To what extent does this job require the worker to compete or to be aware of competitive pressures?

54%

Degree of Automation

How automated is the job?

50%

Physical Proximity

To what extent does this job require the worker to perform job tasks physically close to other people?

45%

Consequence of Error

How serious would the result usually be if the worker made a mistake that was not easily correctable?

43%

Work Outcomes and Results of Other Workers

How responsible is the worker for work outcomes and results of other workers?

34%

In an Enclosed Vehicle or Operate Enclosed Equipment

How often does this job require working in a closed vehicle or operate enclosed equipment (like a car)?

27%

Health and Safety of Other Workers

How much responsibility is there for the health and safety of others in this job?

23%

Pace Determined by Speed of Equipment

How important is it to this job that the pace is determined by the speed of equipment or machinery? (This does not refer to keeping busy at all times on this job.)

21%

Public Speaking

How frequently does your job require public speaking (one speaker with an audience)?

19%

Spend Time Standing

How much does this job require standing?

18%

Outdoors, Exposed to All Weather Conditions

How often does this job require working outdoors, exposed to all weather conditions?

17%

Spend Time Walking or Running

How much does this job require walking or running?

15%

Exposed to Contaminants

How often does this job require working exposed to contaminants (such as pollutants, gases, dust or odors)?

13%

Exposed to Very Hot or Cold Temperatures

How often does this job require working in very hot (above 90 F degrees) or very cold (below 32 F degrees) temperatures?

13%

Exposed to Extremely Bright or Inadequate Lighting Conditions

How often does this job require working in extremely bright or inadequate lighting conditions?

12%

Exposed to High Places

How often does this job require exposure to high places?

11%

Spend Time Bending or Twisting Your Body

How much does this job require bending or twisting your body?

11%

Dealing with Violent or Physically Aggressive People

How frequently does this job require the worker to deal with physical aggression of violent individuals?

10%

Work Schedules

How regular are the work schedules for this job?

9%

Indoors, Not Environmentally Controlled

How often does this job require working in an environment that is not environmentally controlled (like a warehouse without air conditioning)?

7%

Outdoors, Under Cover

How often does this job require working outdoors, under cover (like in an open shed)?

7%

Spend Time Keeping or Regaining Balance

How much does this job require keeping or regaining your balance?

7%

Spend Time Climbing Ladders, Scaffolds, or Poles

How much does this job require climbing ladders, scaffolds, poles, etc.?

6%

Exposed to Cramped Work Space, Awkward Positions

How often does this job require working in cramped work spaces that requires getting into awkward positions?

5%

Exposed to Minor Burns, Cuts, Bites, or Stings

How often does this job require exposure to minor burns, cuts, bites, or stings?

5%

Spend Time Kneeling, Crouching, Stooping, or Crawling

How much does this job require kneeling, crouching, stooping or crawling?

5%

Exposed to Hazardous Equipment

How often does this job require exposure to hazardous equipment?

4%

Exposed to Disease or Infections

How often does this job require exposure to disease/infections?

3%

Exposed to Hazardous Conditions

How often does this job require exposure to hazardous conditions?

3%

Wear Common Protective or Safety Equipment such as Safety Shoes, Glasses, Gloves, Hearing Protection, Hard Hats, or Life Jackets

How often does this job require wearing common protective or safety equipment such as safety shoes, glasses, gloves, hearing protection, hard hats or life-jackets?

3%

Wear Specialized Protective or Safety Equipment such as Breathing Apparatus, Safety Harness, Full Protection Suits, or Radiation Protection

How often does this job require wearing specialized protective or safety equipment such as breathing apparatus, safety harness, full protection suits, or radiation protection?

2%

Exposed to Radiation

How often does this job require exposure to radiation?

1%

Exposed to Whole Body Vibration

How often does this job require exposure to whole body vibration (like operating a jackhammer or earth moving equipment)?

1%

In an Open Vehicle or Operating Equipment

How often does this job require working in an open vehicle or operating equipment (like a tractor)?

1%

Education

Bachelor's degree

56%

High school diploma or equivalent

13%

Some college, no degree

12%

Interests

Conventional

Work involves following procedures and regulations to organize information or data, typically in a business setting. Conventional occupations are often associated with office work, accounting, mathematics/statistics, information technology, finance, or hum

87

Enterprising

Work involves managing, negotiating, marketing, or selling, typically in a business setting, or leading or advising people in political and legal situations. Enterprising occupations are often associated with business initiatives, sales, marketing/advertis

63

Investigative

Work involves studying and researching non-living objects, living organisms, disease or other forms of impairment, or human behavior. Investigative occupations are often associated with physical, life, medical, or social sciences, and can be found in the f

40

Social

Work involves helping, teaching, advising, assisting, or providing service to others. Social occupations are often associated with social, health care, personal service, teaching/education, or religious activities.

27

Realistic

Work involves designing, building, or repairing of equipment, materials, or structures, engaging in physical activity, or working outdoors. Realistic occupations are often associated with engineering, mechanics and electronics, construction, woodworking, t

2

Artistic

Work involves creating original visual artwork, performances, written works, food, or music for a variety of media, or applying artistic principles to the design of various objects and materials. Artistic occupations are often associated with visual arts,

0

Work Styles

Attention to Detail
89%
Dependability
84%
Integrity
84%
Cautiousness
78%
Perseverance
60%
Self-Control
60%
Stress Tolerance
60%
Achievement Orientation
57%
Self-Confidence
55%
Cooperation
46%
Initiative
46%
Intellectual Curiosity
45%
Social Orientation
44%
Tolerance for Ambiguity
44%
Adaptability
42%
Empathy
39%
Sincerity
32%
Leadership Orientation
22%
Humility
18%
Optimism
13%
Innovation
1%

Work Values

Support
64%
Independence
61%
Working Conditions
60%
Relationships
58%
Achievement
53%
Recognition
47%

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