Claims Adjusters, Examiners, and Investigators

• Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
• Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
• Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
• Examine claims forms and other records to determine insurance coverage.
• Resolve complex, severe exposure claims, using high service oriented file handling.
• Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
• 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.
• Present cases and participate in their discussion at claim committee meetings.
• Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
• Collect evidence to support contested claims in court.
• Analyze information gathered by investigation and report findings and recommendations.
• Pay and process claims within designated authority level.
• Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
• Report overpayments, underpayments, and other irregularities.
• Investigate and assess damage to property and create or review property damage estimates.
• Confer with legal counsel on claims requiring litigation.
• 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.
• Refer questionable claims to investigator or claims adjuster for investigation or settlement.
• Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

No durable tasks identified for this role — its real, individually-assessed tasks consistently read as automatable (85%).