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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

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

    Skills

    • Critical Thinking

      Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

    • Reading Comprehension

      Understanding written sentences and paragraphs in work related documents.

    • 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.

    WorkKeys®

    Applied Math
    5
    Workplace Documents
    5
    Graphic Literacy
    4

    Abilities

    • Oral Comprehension

      The ability to listen to and understand information and ideas presented through spoken words and sentences.

    • Written Comprehension

      The ability to read and understand information and ideas presented in writing.

    • Deductive Reasoning

      The ability to apply general rules to specific problems to produce answers that make sense.

    Knowledge

    • 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.

    • English Language

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

    • Law and Government

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

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    Pay

    • Ohio Annual Salary 62580/yr
    • Typical Salary
    • Ohio Hourly Wage 30.09/hr
    • Typical Hourly Wage

    Ohio Employment Trends

    • Currently Employed 12,400
    • 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

    • Portable data input terminals
    • Notebook computers
    • Measuring wheels for distance
    • Desktop computers
    • Automotive computer systems

    Technology

    • Financial analysis software
    • Expert system software
    • Document management software
    • Computer aided design CAD software
    • Analytical or scientific 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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