Claims Adjusters, Examiners, and Investigators — Tasks

Task statements

• Communicate with reinsurance brokers to obtain information necessary for processing claims.
• 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.
• Prepare reports to be submitted to company's data processing department.
• 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.
• 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.
• 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.
• Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
• Resolve complex, severe exposure claims, using high service oriented file handling.
• Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
• Confer with legal counsel on claims requiring litigation.
• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
• Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
• Refer questionable claims to investigator or claims adjuster for investigation or settlement.
• Collect evidence to support contested claims in court.
• Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
• Present cases and participate in their discussion at claim committee meetings.
• Report overpayments, underpayments, and other irregularities.
• Attend mediations or trials.
• Supervise claims adjusters to ensure that adjusters have followed proper methods.
• Conduct detailed bill reviews to implement sound litigation management and expense control.
• Examine titles to property to determine validity and act as company agent in transactions with property owners.
• Obtain credit information from banks and other credit services.
• Communicate with former associates to verify employment record or to obtain background information regarding persons or businesses applying for credit.
• Negotiate claim settlements or recommend litigation when settlement cannot be negotiated.