Skip navigation

Claims Adjusters, Examiners, and Investigators - 13-1031.00

O*NET-SOC Description

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.

Sample of Reported Job Titles

No information available.

SOC Occupation Groups

Related Occupations

Tasks

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

Detailed Work Activities

  • Advise others on financial matters.
  • Advise others on legal or regulatory compliance matters.
  • Appraise property values.
  • Calculate data to inform organizational operations.
  • Collect evidence for legal proceedings.
  • Confer with others about financial matters.
  • Estimate costs of goods or services.
  • Examine financial records.
  • Gather financial records.
  • Implement financial decisions.
  • Interview witnesses, suspects, or claimants.
  • Investigate legal issues.
  • Maintain data in information systems or databases.
  • Meet with individuals involved in legal processes to provide information and clarify issues.
  • Negotiate agreements to resolve disputes.
  • Pay charges, fees, or taxes.
  • Prepare financial documents.
  • Prepare legal or investigatory documentation.
  • Prepare operational reports.
  • Present business-related information to audiences.
  • Report information to managers or other personnel.
  • Supervise employees.
  • Verify accuracy of records.
  • Verify application data to determine program eligibility.

Military Crosswalk Titles

  • Paralegal (Air Force - Enlisted)
  • Paralegal Apprentice (Air Force - Enlisted)
  • Paralegal Craftsman (Air Force - Enlisted)
  • Paralegal Helper (Air Force - Enlisted)
  • Paralegal Journeyman (Air Force - Enlisted)
  • Paralegal Superintendent (Air Force - Enlisted)

Apprenticeship Crosswalk Titles

  • Disability Analyst

DOT Crosswalk Titles

  • Claim Adjuster
  • Claim Agent
  • Claim Examiner