Insurance Claims?

Question

Can anyone tell me exactly what an insurance claims person does? What's the environment like? And what kind of degree/job experience is usually required.

thanks

Answer 1

We do tons of things. Some are fun, some aren't. The job is NEVER boring.

There are two main types of claim adjusters - inside and outside or sometimes called field adjuster.



I'm a field adjuster and I like that much better than sitting behind a desk with some no-brain claim supervisor looking over my shoulder.

Both jobs involve many of the same things. The field adjuster just does more of them in a face to face environment.

You would determine if a claim is covered under the policy based on the policy provisions and exclusions.

You would talk to people involved in claims and possibly take a recorded statement from them about what happened.

You would write damage estimates or possibly just review them. Then you might get to argue with a body shop or contractor about what you will and won't pay for.

You could investigate fraudulent claims.

You will have many customer service opportunities each day.

You will have a good chance of getting more files than you could ever handle.

Some of the bigger companies will hire college grads as entry level adjusters. I'm not sure what degrees they prefer. That way they can brainwash you into handling claims their way.

Many of the people who enter into claims have a background in auto body repair, house building or being an insurance agent.

If you work for a big company the pay and benefits can be very good. However, if you are an inside adjuster you have to learn to like working in a cubicle farm.

Answer 2

Exactly what he said.  

I am a Disability Claim Analyst, so my job is entirely in office.  Like the answers above and below, most of the positions require degrees or college level certifications (for example, LOMA or ICA).  The pay is great, the benefits are wonderful, and the job is exciting.  

In the disability claim environment, we review contracts and plans to determine whether the claim falls under the guidelines, we review clinical information to determine whether the claimant is contractually disabled, administer benefit payments, and manage the claim.  This sounds so simple when typing it out, but there are so many different situations and scenarios that every day is different.

If you like medical or clinical, and insurance, disability insurance is a great option for you.  Plus, like I said, dealing with all the "extras" that come up...taxes, insufficient clinical information, overpayments, underpayments, missing checks, payment collection and reporting are just some examples.

You deal a lot with many different parties, like employers, employees, lawyers, doctors, etc.  You gotta love insurance!  =)

Answer 3

I'm the opposite of what the guy above was -- he's a field adjuster, I'm a regular old office adjuster.

I love my job, and the environment at my company is superb.  I get paid really well, and have amazing benefits.  I do have a college degree.  They hire some people without college degrees, but they must be actively enrolled in college classes, they can't handle as much as we can, and of course they get paid about $20k less.  Their jobs are pretty boring, but mine is great.

Basically, once a claim is reported, it comes to me.  I have to first contact the insured to find out what happened, and to obtain any documentation they might have -- i.e. if it is an auto claim, police reports, witness names, photos, etc.

Next I contact the claimant, or the other person involved in the claim.  I get their version of the story, and any documentation they might have.

There is a lot of investigation involved, a lot of digging, and a lot of fraud to be found.  So you learn to be a human lie-detector.

After your investigation is complete, you determine who was at fault.  This isn't always clear, so sometimes it might be 80% on one party and 20% on another, etc.

Then you go on to figure out how much the claim is worth.  You do this through estimates, repair receipts, medical records, bills, wage loss information, etc.

Finally, you come to a value, then work to settle the claim.

If you have an analytical mind, this might be the job for you.