Claims Adjusters, Examiners, and 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.

On the job, you would:

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.

Important Qualities

Analytical skills. Adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm regarding their company’s policies.

Personality

A3	Your Strengths	Importance	Characteristics of this Career
		91%	Stress Tolerance - Job requires accepting criticism and dealing calmly and effectively with high-stress situations.
		91%	Integrity - Job requires being honest and ethical.
		90%	Dependability - Job requires being reliable, responsible, and dependable, and fulfilling obligations.
		89%	Attention to Detail - Job requires being careful about detail and thorough in completing work tasks.
		88%	Initiative - Job requires a willingness to take on responsibilities and challenges.
		86%	Independence - Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
		86%	Achievement/Effort - Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
		85%	Cooperation - Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
		85%	Persistence - Job requires persistence in the face of obstacles.
		85%	Adaptability/Flexibility - Job requires being open to change (positive or negative) and to considerable variety in the workplace.
		85%	Self-Control - Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
		81%	Concern for Others - Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
		80%	Analytical Thinking - Job requires analyzing information and using logic to address work-related issues and problems.
		73%	Leadership - Job requires a willingness to lead, take charge, and offer opinions and direction.
		70%	Social Orientation - Job requires preferring to work with others rather than alone, and being personally connected with others on the job.
		69%	Innovation - Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems.

A3	Your Strengths	Importance	Strengths
		95%	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 human resources.
		72%	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/advertising, finance, management/administration, professional advising, public speaking, politics, or law.

A3	Your Strengths	Importance	Values of the Work Environment
		64%	Support - Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
		61%	Independence - Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
		60%	Working Conditions - Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.
		58%	Relationships - Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
		53%	Achievement - Occupations that satisfy this work value are results oriented and allow employees to use their strongest abilities, giving them a feeling of accomplishment. Corresponding needs are Ability Utilization and Achievement.

Aptitude

A3	Your Strengths	Importance	Abilities \| Cognitive, Physical, Personality
		85%	Written Comprehension - The ability to read and understand information and ideas presented in writing.
		78%	Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences.
		78%	Oral Expression - The ability to communicate information and ideas in speaking so others will understand.
		75%	Inductive Reasoning - The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
		75%	Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
		72%	Near Vision - The ability to see details at close range (within a few feet of the observer).
		72%	Written Expression - The ability to communicate information and ideas in writing so others will understand.
		66%	Speech Clarity - The ability to speak clearly so others can understand you.
		66%	Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
		63%	Information Ordering - The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
		63%	Speech Recognition - The ability to identify and understand the speech of another person.
		60%	Category Flexibility - The ability to generate or use different sets of rules for combining or grouping things in different ways.
		56%	Flexibility of Closure - The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material.

A3	Your Strengths	Importance	Skills \| Cognitive, Physical, Personality
		64%	Reading Comprehension - Understanding written sentences and paragraphs in work-related documents.
		61%	Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
		61%	Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
		57%	Speaking - Talking to others to convey information effectively.
		55%	Writing - Communicating effectively in writing as appropriate for the needs of the audience.
		55%	Monitoring - Monitoring/Assessing performance of yourself, other individuals, or organizations to make improvements or take corrective action.
		54%	Judgment and Decision Making - Considering the relative costs and benefits of potential actions to choose the most appropriate one.

Job Details

Responsibilities

Calculate data to inform organizational operations.

Investigate legal issues.

Prepare legal or investigatory documentation.

Estimate costs of goods or services.

Appraise property values.

Interview witnesses, suspects, or claimants.

Investigate legal issues.

Negotiate agreements to resolve disputes.

Implement financial decisions.

Advise others on financial matters.

Apply information technology to solve business or other applied problems.

Resolve customer complaints or problems.

Pay charges, fees, or taxes.

Investigate legal issues.

Verify accuracy of records.

Maintain data in information systems or databases.

Report information to managers or other personnel.

Collect evidence for legal proceedings.

Meet with individuals involved in legal processes to provide information and clarify issues.

Interview witnesses, suspects, or claimants.

Prepare financial documents.

Present business-related information to audiences.

Supervise employees.

Examine financial records.

Verify accuracy of records.

Report information to managers or other personnel.

Confer with others about financial matters.

Prepare operational reports.

Gather financial records.

Investigate legal issues.

Verify application data to determine program eligibility.

Negotiate agreements to resolve disputes.

Advise others on legal or regulatory compliance matters.

A3	Your Strengths	Importance	Attributes & Percentage of Time Spent
		100%	Telephone - How often do you have telephone conversations in this job?
		100%	Electronic Mail - How often do you use electronic mail in this job?
		98%	Letters and Memos - How often does the job require written letters and memos?
		97%	Frequency of Decision Making - How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?
		92%	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?
		91%	Spend Time Sitting - How much does this job require sitting?
		90%	Importance of Being Exact or Accurate - How important is being very exact or highly accurate in performing this job?
		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 is repeating the same physical activities (e.g., key entry) or mental activities (e.g., checking entries in a ledger) over and over, without stopping, to performing this job?
		88%	Freedom to Make Decisions - How much decision making freedom, without supervision, does the job offer?
		86%	Deal With External Customers - How important is it to work with external customers or the public in this job?
		85%	Time Pressure - How often does this job require the worker to meet strict deadlines?
		83%	Indoors, Environmentally Controlled - How often does this job require working indoors in environmentally controlled conditions?
		83%	Structured versus Unstructured Work - To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals?
		82%	Face-to-Face Discussions - How often do you have to have face-to-face discussions with individuals or teams in this job?
		78%	Deal With Unpleasant or Angry People - How frequently does the worker have to deal with unpleasant, angry, or discourteous individuals as part of the job requirements?
		76%	Frequency of Conflict Situations - How often are there conflict situations the employee has to face in this job?
		72%	Work With Work Group or Team - How important is it to work with others in a group or team in this job?
		57%	Spend Time Making Repetitive Motions - How much does this job require making repetitive motions?
		56%	Sounds, Noise Levels Are Distracting or Uncomfortable - How often does this job require working exposed to sounds and noise levels that are distracting or uncomfortable?
		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%	Coordinate or Lead Others - How important is it to coordinate or lead others in accomplishing work activities in this job?
		54%	Level of Competition - To what extent does this job require the worker to compete or to be aware of competitive pressures?
		59%	Duration of Typical Work Week - Number of hours typically worked in one week.

A3	Your Strengths	Importance	Tasks & Values
		92%	Working with Computers - Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
		90%	Communicating with People Outside the Organization - Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
		89%	Getting Information - Observing, receiving, and otherwise obtaining information from all relevant sources.
		87%	Making Decisions and Solving Problems - Analyzing information and evaluating results to choose the best solution and solve problems.
		87%	Identifying Objects, Actions, and Events - Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
		85%	Communicating with Supervisors, Peers, or Subordinates - Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
		84%	Documenting/Recording Information - Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
		82%	Resolving Conflicts and Negotiating with Others - Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
		81%	Organizing, Planning, and Prioritizing Work - Developing specific goals and plans to prioritize, organize, and accomplish your work.
		76%	Analyzing Data or Information - Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
		76%	Processing Information - Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
		75%	Establishing and Maintaining Interpersonal Relationships - Developing constructive and cooperative working relationships with others, and maintaining them over time.
		75%	Updating and Using Relevant Knowledge - Keeping up-to-date technically and applying new knowledge to your job.
		71%	Evaluating Information to Determine Compliance with Standards - Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
		69%	Interpreting the Meaning of Information for Others - Translating or explaining what information means and how it can be used.
		64%	Monitoring Processes, Materials, or Surroundings - Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
		64%	Judging the Qualities of Objects, Services, or People - Assessing the value, importance, or quality of things or people.
		64%	Performing for or Working Directly with the Public - Performing for people or dealing directly with the public. This includes serving customers in restaurants and stores, and receiving clients or guests.
		58%	Estimating the Quantifiable Characteristics of Products, Events, or Information - Estimating sizes, distances, and quantities; or determining time, costs, resources, or materials needed to perform a work activity.
		55%	Performing Administrative Activities - Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.

What Claims Adjusters, Appraisers, Examiners, and Investigators Do

Claims adjusters inspect property damage to determine how much the company should pay for the loss.

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and if so, how much.

Duties

Claims adjusters, appraisers, examiners, and investigators typically do the following:

Investigate, evaluate, and settle insurance claims
Determine whether the insurance policy covers the loss claimed
Decide the appropriate amount the insurance company should pay
Ensure that claims are not fraudulent
Contact claimants’ doctors or employers to get additional information on questionable claims
Talk with legal counsel about claims when needed
Negotiate settlements
Authorize payments

Claims adjusters, appraisers, examiners, and investigators have varying duties, depending on the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs so that they can properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable.

Adjusters inspect property damage or personal injury claims to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile.

Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. They may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

Adjusters gather information—including photographs and statements, either written or recorded on audio or video—and put together a report for claims examiners to review. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer’s position.

Some claims adjusters work as public adjusters. Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant. They are paid a percentage of the settled claim.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to make sure claimants and adjusters followed proper guidelines. They may help adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from overstated claims of vehicle damage to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does anything that would be suspicious based on injuries stated in the claim.

Work Environment

Claims adjusters, examiners, and investigators held about 329,000 jobs in 2022. The largest employers of claims adjusters, examiners, and investigators were as follows:

Direct insurance (except life, health, and medical) carriers	33%
Agencies, brokerages, and other insurance related activities	28
Federal government	14
Direct health and medical insurance carriers	8
State government, excluding education and hospitals	3

Insurance appraisers, auto damage held about 13,600 jobs in 2022. The largest employers of insurance appraisers, auto damage were as follows:

Insurance carriers	68%
Agencies, brokerages, and other insurance related activities	25
Self-employed workers	1

Claims adjusters and examiners work in offices when reviewing documents and conducting research. They work outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged automobiles and buildings and conducting surveillance. Auto damage appraisers spend much of their time at automotive body shops estimating vehicle damage costs.

Workers who inspect damaged buildings must be careful around potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Work Schedules

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules may vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.

Insurance investigators often work irregular schedules because of the need to contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

Getting Started

Education:

56%

Bachelor's Degree

13%

High School Diploma - or the equivalent (for example, GED)

How to Become a Claims Adjuster, Appraiser, Examiner, or Investigator

At the beginning of their careers, claims adjusters, appraisers, examiners, and investigators work on small claims, under the supervision of an experienced worker.

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator, although some positions require a bachelor’s degree or insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster or examiner. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Some insurance companies prefer to hire people trained as law enforcement officers or private investigators, because these workers have good interviewing and interrogation skills.

Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair. Many vocational schools and some community colleges offer programs in autobody repair that teach students how to estimate the cost of repairing damaged vehicles.

Training

Entry-level claims adjusters, examiners, and investigators work on small claims under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of an experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on their own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both). Jobseekers should verify the licensing laws with the state and locality in which they want to work.

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and the outcomes of claim disputes adjudicated in court affect how the claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and prescription drugs. Examiners working on auto claims must be familiar with the most recent car models and repair techniques. To fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

The National Insurance Producer Registry (NIPR) provides information about state licensing requirements.

Job Outlook

Overall employment of claims adjusters, appraisers, examiners, and investigators is projected to decline 3 percent from 2022 to 2032.

Despite declining employment, about 21,500 openings for claims adjusters, appraisers, examiners, and investigators are projected each year, on average, over the decade. All of those openings are expected to result from the need to replace workers who transfer to other occupations or exit the labor force, such as to retire.

Employment

Technology is expected to automate some of the tasks that these workers currently perform. For example, computer software can evaluate photographs of damaged property and calculate an estimated claim amount. In addition, data collection and processing speed will continue to increase, which will improve efficiency and make workers more productive.

The number of natural disasters, such as floods and fires, influences demand for claims adjusters in property and casualty insurance. Future increases in the number of natural disasters could result in some employment growth for claims adjusters in the field.

Contacts for More Information

For more information about education and credentials for insurance-related occupations, visit

The Institutes

International Claim Association

National Association of Public Insurance Adjusters

For more information about state licensing requirements, check with your state insurance agency or visit

National Insurance Producer Registry (NIPR)

Similar Occupations

This table shows a list of occupations with job duties that are similar to those of claims adjusters, appraisers, examiners, and investigators.

Occupation	Job Duties	Entry-Level Education	Median Annual Pay, May 2022
Property Appraisers and Assessors	Property appraisers and assessors provide a value estimate on real estate and on tangible personal and business property.	Bachelor's degree	$61,560
Automotive Body and Glass Repairers	Automotive body and glass repairers restore, refinish, and replace vehicle bodies and frames, windshields, and window glass.	High school diploma or equivalent	$47,270
Automotive Service Technicians and Mechanics	Automotive service technicians and mechanics inspect, maintain, and repair cars and light trucks.	Postsecondary nondegree award	$46,970
Construction and Building Inspectors	Construction and building inspectors ensure that construction meets building codes and ordinances, zoning regulations, and contract specifications.	High school diploma or equivalent	$64,480
Cost Estimators	Cost estimators collect and analyze data in order to assess the time, money, materials, and labor required to make a product or provide a service.	Bachelor's degree	$71,200
Fire Inspectors	Fire inspectors detect fire hazards, recommend prevention measures, ensure compliance with state and local fire regulations, and investigate causes of fires.	See How to Become One	$65,800

Claims Adjusters, Examiners, and Investigators

Claims Adjuster, Appraiser, Examiner, or Investigator

What they do:

On the job, you would:

Important Qualities

Personality

Characteristics of this Career

Strengths

Values of the Work Environment

Aptitude

Abilities | Cognitive, Physical, Personality

Skills | Cognitive, Physical, Personality

Job Details

Attributes & Percentage of Time Spent

Tasks & Values

What Claims Adjusters, Appraisers, Examiners, and Investigators Do

Duties

Work Environment

Work Schedules

Getting Started

How to Become a Claims Adjuster, Appraiser, Examiner, or Investigator

Education

Training

Licenses, Certifications, and Registrations

Job Outlook

Employment

Contacts for More Information

Similar Occupations