Claims Adjusters, Examiners, Investigators and Appraisers

Claims adjusters, examiners, investigators and appraisers are all involved in the process of evaluating insurance claims made by claimants. They're tasked with the responsibility of determining if a claim should be paid, and if so, how much should be paid out for the claim. Other job responsibilities include detecting fraudulent claims, gathering claim information from doctors, employers and other parties involved, confering with attorneys, negotiating settlements, and authorizing insurance payments.

The duties of a claims adjuster, appraiser, examiner, or investigator will be determined in large part by the type of insurance company the work with. For example, an adjuster working with a property and casualty insurance company is very involved in settling claims relating to damage of buildings, automobiles, and associated property and persons. Conversely, adjusters working in the health insurance industry must review medical claims made be individuals and employers to determine eligibility for benefits and compensation for claims.

Adjusters primarily focus on determining how much an insurance company should pay out for losses. They often must inspect physical property including homes, buildings, businesses, and automobiles. As part of this process they question claimants and witnesses, inspect damaged property and review police reports. They also work closely with engineers, attorneys, doctors, architects and accountants.

Public adjusters perform many of the same tasks as private adjusters. However, they are typically self-employed and are hired by claimants who want an adjuster independent from the insurance company to assess losses and determine payments that should be made. Public adjusters represent the claimant and try to get the largest settlement they can for their client. They are typicaly paid a percentage of any claim they settle. Lawyers sometimes perform the duties of a public adjuster for their clients.

Appraisers determine how much a piece of property is worth and how much it should be insured for. The most common type of appraisers are automobile appraisers. They examine vehicles that have been damaged in accidents and calculate repair costs. Appaisers send their findings to adjusters, who include those costs in the settlement they'll present to the claimant.

Claims examiners work hand in hand with adjusters. They make sure that all the proper steps have been taken and that all guidelines have been adhered to by both claimants and insurance adjusters. While a few claim examiners work for property and casualty company, the majority work for life or health insurance companies. They will authorize settlements and medical payments, deny claims that look unreasonable or shaddy, and even refer claims which appear fraudulent to an investigator for further examination. Examiners that work for life insurance companies review life insurance applications, assess insurance risk and review causes of death to make sure the cause of death was accidental.

Insurance investigators are responsible for reviewing claims that appraisers and/or examiners believe to involve fraud. Arson, false medical claims, overstatement of damage, fraud rings and staged accidents are just a few of the things that insurance investigators deal with on a regular basis. It's not uncommon for insurance investigator to perform surveillance work (often the case when examining suspicion of workers' compensation fraud.)

As of 2012, there were approximately 312,000 claims adjusters, examiners, appraisers, and investigators employed in the United States. These professionals work in a variety of environments. Claims adjusters spend a fair amount of their time in offices reviewing documents and putting together settlements. However, they also work outside, in the field, examining damaged property. Appraisers spend much more time outside than in the office. They spend the majority of their time inspecting damaged property, including vehicles and buildings. Appaisers who are primarily responsible for assessing damage to vehicles, may work full-time in automotive body shops.

The majority (49%) of claims adjusters, examiners, appraisers, and investigators work with insurance companies. About 22% work for agencies, brokerages and other insurance related companies. 19% are employed by federal and state government agencies and a select few work in management.

Claims adjusters, appraisers, examiners, and investigators typically work a full-time 9 to 5 week, just like workers in most occupation. However, adjusters are often required to work evenings and weekends as they must be available to assess and examine accidents and property damage when they occur. Due to the surveillance they often conduct, insurance investigators must also keep irregular work schedules and hours.

Earning a high school diploma, GED or equivalent is usually the minimum entry-level requirement for becoming a claims adjuster, examiner, or investigator. However, more and more employers are now favoring candidates with a bachelor's degree or specialized vocational training. Supervisory and management positions typically require either a bachelor's or master's degree.

Automobile damage appraisers are usually required to have an advanced education and/or experience in a repair shop estimating auto repair costs.

Regardless of the specific occupation, earning a college degree qualifies workers for better positions and career opportunities. Earning a degree in business or accounting is a great asset for a claims adjuster or examiner that must assess financial loss and create equitable insurance settlements. A college degree in architecture or engineering is useful for adjusters who must review industrial claims involving damage of buildings and equipment. A law degree is also a great asset for adjusters who must deal with product liability claims and related cases. An advanced education in medicine or healthcare is useful for appraisers and examiners who handle health, medical and life insurance claims.

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While a high school diploma is the minimum requirement for becoming an insurance investigator, most insurance companies prefer hiring professionals with a background in law enforcement or private investigations.

In order to become a claims adjuster, appraiser, examiner, or investigator, many states have licensing requirements. Some states have very stringent licensing requirements, while licensing requirements in other states are quite lax. Continuing education credits may also be required in some states in order to maintain a current license.

The current median annual pay for claims adjusters, examiners, and investigators is roughly $60,000. The lowest 10% of workers in these occupations make less than $40,000 a year, while the top 10% of earners make over $90,000 a year.

At just 3%, job growth for claims adjusters, appraisers, examiners, and investigators, relative to all other occupations nationwide, is predicted to be quite low. Most new job opportunities will come from growth in the health health insurance industry. As the individual coverage mandate, under the affordable care act, takes effect, more health insurance claims will be made and more claims adjusters and examiners will be needed to process these claims, approve treatments and determine what will be paid out to claimants.

The demand for property and casualty claims adjusters is tied to the number of floods, fires and other natural disasters that occur. According to FEMA, the number of natural disasters is on the rise, which is good news if you're looking for a career in property and casualty insurance, but not so good news if you're living in a disaster zone.