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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.

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    Work Activities

    Work Activities

    • Report overpayments, underpayments, and other irregularities.
    • Examine claims forms and other records to determine insurance coverage.
    • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
    • Pay and process claims within designated authority level.
    • Obtain credit information from banks and other credit services.
    • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
    • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
    • Examine titles to property to determine validity and act as company agent in transactions with property owners.
    • Prepare reports to be submitted to company's data processing department.
    • Analyze information gathered by investigation and report findings and recommendations.
    • Supervise claims adjusters to ensure that adjusters have followed proper methods.
    • Present cases and participate in their discussion at claim committee meetings.
    • 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.
    • Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
    • Analyze information gathered by investigation and report findings and recommendations.
    • Confer with legal counsel on claims requiring litigation.
    • Investigate and assess damage to property and create or review property damage estimates.
    • Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
    • 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.
    • Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
    • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
    • Refer questionable claims to investigator or claims adjuster for investigation or settlement.
    • Communicate with reinsurance brokers to obtain information necessary for processing claims.
    • 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.
    • Conduct detailed bill reviews to implement sound litigation management and expense control.
    • Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
    • Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
    • Collect evidence to support contested claims in court.

    Skills

    • Monitoring

      Keeping track of how well people and/or groups are doing in order to make improvements.

    • Complex Problem Solving

      Noticing a problem and figuring out the best way to solve it.

    • Active Learning

      Figuring out how to use new ideas or things.

    • Technology Design

      Making equipment and technology useful for customers.

    • Systems Analysis

      Figuring out how a system should work and how changes in the future will affect it.

    • Operation and Control

      Using equipment or systems.

    • Management of Personnel Resources

      Selecting and managing the best workers for a job.

    • Learning Strategies

      Using the best training or teaching strategies for learning new things.

    • Quality Control Analysis

      Testing how well a product or service works.

    • Management of Material Resources

      Managing equipment and materials.

    • Social Perceptiveness

      Understanding people's reactions.

    • Installation

      Installing equipment, machines, wiring, or computer programs.

    • Time Management

      Managing your time and the time of other people.

    • Operations Monitoring

      Watching gauges, dials, or display screens to make sure a machine is working.

    • Mathematics

      Using math to solve problems.

    • Instructing

      Teaching people how to do something.

    • Active Listening

      Listening to others, not interrupting, and asking good questions.

    • Writing

      Writing things for co-workers or customers.

    • Speaking

      Talking to others.

    • Equipment Selection

      Deciding what kind of tools and equipment are needed to do a job.

    • Coordination

      Changing what is done based on other people's actions.

    • Critical Thinking

      Thinking about the pros and cons of different ways to solve a problem.

    • Negotiation

      Bringing people together to solve differences.

    • Troubleshooting

      Figuring out what is causing equipment, machines, wiring, or computer programs to not work.

    • Repairing

      Repairing machines or systems using the right tools.

    • Management of Financial Resources

      Making spending decisions and keeping track of what is spent.

    • Science

      Using scientific rules and strategies to solve problems.

    • Persuasion

      Talking people into changing their minds or their behavior.

    • Programming

      Writing computer programs.

    • Equipment Maintenance

      Planning and doing the basic maintenance on equipment.

    • Service Orientation

      Looking for ways to help people.

    • Reading Comprehension

      Reading work-related information.

    • Judgment and Decision Making

      Thinking about the pros and cons of different options and picking the best one.

    • Operations Analysis

      Figuring out what a product or service needs to be able to do.

    • Systems Evaluation

      Measuring how well a system is working and how to improve it.

    WorkKeys®

    Applied Math
    5
    Workplace Documents
    5
    Graphic Literacy
    4

    Abilities

    • Written Expression

      Communicating by writing.

    • Visual Color Discrimination

      Noticing the difference between colors, including shades and brightness.

    • Sound Localization

      Noticing the direction that a sound came from.

    • Written Comprehension

      Reading and understanding what is written.

    • Spatial Orientation

      Knowing where things are around you.

    • Problem Sensitivity

      Noticing when problems happen.

    • Control Precision

      Quickly changing the controls of a machine, car, truck or boat.

    • Time Sharing

      Doing two or more things at the same time.

    • Oral Comprehension

      Listening and understanding what people say.

    • Speed of Limb Movement

      Quickly moving your arms and legs.

    • Deductive Reasoning

      Using rules to solve problems.

    • Explosive Strength

      Jumping, sprinting, or throwing something.

    • Response Orientation

      Quickly deciding if you should move your hand, foot, or other body part.

    • Mathematical Reasoning

      Choosing the right type of math to solve a problem.

    • Selective Attention

      Paying attention to something without being distracted.

    • Perceptual Speed

      Quickly comparing groups of letters, numbers, pictures, or other things.

    • Wrist-Finger Speed

      Making fast, simple, repeated movements of your fingers, hands, and wrists.

    • Gross Body Coordination

      Moving your arms, legs, and mid-section together while your whole body is moving.

    • Arm-Hand Steadiness

      Keeping your arm or hand steady.

    • Glare Sensitivity

      Seeing something even if there is a glare or very bright light.

    • Information Ordering

      Ordering or arranging things.

    • Finger Dexterity

      Putting together small parts with your fingers.

    • Speed of Closure

      Quickly knowing what you are looking at.

    • Extent Flexibility

      Bending, stretching, twisting, or reaching with your body, arms, and/or legs.

    • Inductive Reasoning

      Making general rules or coming up with answers from lots of detailed information.

    • Multilimb Coordination

      Using your arms and/or legs together while sitting, standing, or lying down.

    • Dynamic Strength

      Exercising for a long time without your muscles getting tired.

    • Night Vision

      Seeing at night or under low light.

    • Memorization

      Remembering words, numbers, pictures, or steps.

    • Stamina

      Exercising for a long time without getting out of breath.

    • Hearing Sensitivity

      Telling the difference between sounds.

    • Auditory Attention

      Paying attention to one sound while there are other distracting sounds.

    • Depth Perception

      Deciding which thing is closer or farther away from you, or deciding how far away it is from you.

    • Dynamic Flexibility

      Quickly and repeatedly bending, stretching, twisting, or reaching out with your body, arms, and/or legs.

    • Oral Expression

      Communicating by speaking.

    • Category Flexibility

      Grouping things in different ways.

    • Fluency of Ideas

      Coming up with lots of ideas.

    • Number Facility

      Adding, subtracting, multiplying, or dividing.

    • Trunk Strength

      Using your lower back and stomach.

    • Flexibility of Closure

      Seeing hidden patterns.

    • Static Strength

      Lifting, pushing, pulling, or carrying.

    • Manual Dexterity

      Holding or moving items with your hands.

    • Visualization

      Imagining how something will look after it is moved around or changed.

    • Reaction Time

      Quickly moving your hand, finger, or foot based on a sound, light, picture or other command.

    • Originality

      Creating new and original ideas.

    • Rate Control

      Changing when and how fast you move based on how something else is moving.

    • Speech Clarity

      Speaking clearly.

    • Gross Body Equilibrium

      Keeping your balance or staying upright.

    • Peripheral Vision

      Seeing something to your side when your are looking ahead.

    • Near Vision

      Seeing details up close.

    • Far Vision

      Seeing details that are far away.

    • Speech Recognition

      Recognizing spoken words.

    Knowledge

    • Philosophy and Theology

      Knowledge of different philosophical systems and religions. This includes their basic principles, values, ethics, ways of thinking, customs, practices, and their impact on human culture.

    • Therapy and Counseling

      Knowledge of principles, methods, and procedures for diagnosis, treatment, and rehabilitation of physical and mental dysfunctions, and for career counseling and guidance.

    • Education and Training

      Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects.

    • Mechanical

      Knowledge of machines and tools, including their designs, uses, repair, and maintenance.

    • Communications and Media

      Knowledge of media production, communication, and dissemination techniques and methods. This includes alternative ways to inform and entertain via written, oral, and visual media.

    • Physics

      Knowledge and prediction of physical principles, laws, their interrelationships, and applications to understanding fluid, material, and atmospheric dynamics, and mechanical, electrical, atomic and sub-atomic structures and processes.

    • English Language

      Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

    • Fine Arts

      Knowledge of the theory and techniques required to compose, produce, and perform works of music, dance, visual arts, drama, and sculpture.

    • Biology

      Knowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.

    • Foreign Language

      Knowledge of the structure and content of a foreign (non-English) language including the meaning and spelling of words, rules of composition and grammar, and pronunciation.

    • Transportation

      Knowledge of principles and methods for moving people or goods by air, rail, sea, or road, including the relative costs and benefits.

    • Law and Government

      Knowledge of laws, legal codes, court procedures, precedents, government regulations, executive orders, agency rules, and the democratic political process.

    • Chemistry

      Knowledge of the chemical composition, structure, and properties of substances and of the chemical processes and transformations that they undergo. This includes uses of chemicals and their interactions, danger signs, production techniques, and disposal methods.

    • Sales and Marketing

      Knowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.

    • Computers and Electronics

      Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

    • Personnel and Human Resources

      Knowledge of principles and procedures for personnel recruitment, selection, training, compensation and benefits, labor relations and negotiation, and personnel information systems.

    • Mathematics

      Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

    • Geography

      Knowledge of principles and methods for describing the features of land, sea, and air masses, including their physical characteristics, locations, interrelationships, and distribution of plant, animal, and human life.

    • Sociology and Anthropology

      Knowledge of group behavior and dynamics, societal trends and influences, human migrations, ethnicity, cultures, and their history and origins.

    • Production and Processing

      Knowledge of raw materials, production processes, quality control, costs, and other techniques for maximizing the effective manufacture and distribution of goods.

    • Public Safety and Security

      Knowledge of relevant equipment, policies, procedures, and strategies to promote effective local, state, or national security operations for the protection of people, data, property, and institutions.

    • History and Archeology

      Knowledge of historical events and their causes, indicators, and effects on civilizations and cultures.

    • Medicine and Dentistry

      Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.

    • Psychology

      Knowledge of human behavior and performance; individual differences in ability, personality, and interests; learning and motivation; psychological research methods; and the assessment and treatment of behavioral and affective disorders.

    • Administrative

      Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.

    • Telecommunications

      Knowledge of transmission, broadcasting, switching, control, and operation of telecommunications systems.

    • Building and Construction

      Knowledge of materials, methods, and the tools involved in the construction or repair of houses, buildings, or other structures such as highways and roads.

    • Economics and Accounting

      Knowledge of economic and accounting principles and practices, the financial markets, banking, and the analysis and reporting of financial data.

    • Design

      Knowledge of design techniques, tools, and principles involved in production of precision technical plans, blueprints, drawings, and models.

    • Engineering and Technology

      Knowledge of the practical application of engineering science and technology. This includes applying principles, techniques, procedures, and equipment to the design and production of various goods and services.

    • Administration and Management

      Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

    • Food Production

      Knowledge of techniques and equipment for planting, growing, and harvesting food products (both plant and animal) for consumption, including storage/handling techniques.

    • Customer and Personal Service

      Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

    Career Video

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    Pay

    • Ohio Annual Salary 62320/yr
    • Typical Salary
    • Ohio Hourly Wage 29.96/hr
    • Typical Hourly Wage

    Ohio Employment Trends

    • Currently Employed 11,840
    • Yearly Projected Openings 970

    Typical Education

    Personality

    Conventional: People interested in this work like activities that include data, detail, and regular routines.They do well at jobs that need:
    • Integrity
    • Dependability
    • Attention to Detail
    • Stress Tolerance
    • Self Control
    • Independence

    Tools

    • Automotive computer systems
    • Desktop computers
    • Measuring wheels for distance
    • Notebook computers
    • Personal computers
    • Personal digital assistant PDAs or organizers
    • Portable data input terminals
    • Scanners
    • Tablet computers
    • Theodolites

    Technology

    • Access software
    • Analytical or scientific software
    • Computer aided design CAD software
    • Data base reporting software
    • Data base user interface and query software
    • Desktop publishing software
    • Document management software
    • Enterprise resource planning ERP software
    • Expert system software
    • Financial analysis software
    • Information retrieval or search software
    • Interactive voice response software
    • Medical software
    • Office suite software
    • Presentation software
    • Spreadsheet software
    • Word processing software

    Tags

    • InDemand occupations are considered a priority by the state of Ohio.
    • Apprenticeships are available for this occupation. These programs can help you get hands-on experience and build your skills.
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    The Workforce Supply Tool provides statistics for the occupations in highest demand throughout Ohio.

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