Insurance Adjuster, Examiner or Investigator
Individuals and businesses purchase insurance policies to protect against monetary losses. In the event of a loss, policyholders submit claims seeking compensation for their loss. Adjusters, appraisers, examiners and investigators deal with those claims. They work primarily for property and casualty insurance companies, for whom they handle a wide variety of claims alleging property damage, liability, or bodily injury. Their main role is to investigate claims, negotiate settlements and authorize payments to claimants – the policyholders who make a claim. They must be mindful not to violate their rights under Federal and State privacy laws. They must determine whether the customer's insurance policy covers the loss and how much of the loss should be paid. Although many adjusters, appraisers, examiners and investigators have overlapping functions and may even perform the same tasks, the insurance industry generally assigns specific roles to each of these claims workers.TCC programs that are right for you:
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Working environments of claims adjusters, appraisers, examiners and investigators vary greatly. Many claims adjusters and auto damage appraisers often work outside the office, inspecting damaged buildings and automobiles. Adjusters who inspect damaged buildings must be wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures. Some adjusters report to the office every morning to get their assignments, while others simply call in from home and spend their days traveling to claim sites. Occasionally, experienced adjusters must be away from home for days – for example, when they travel to the scene of a disaster such as a tornado, hurricane, or flood – to work with local adjusters and government officials. Most claims examiners employed by life and health insurance companies work a standard 5-day, 40-hour week in a typical office environment. In contrast, adjusters often must arrange their work schedules to accommodate evening and weekend appointments with clients. This sometimes results in adjusters working irregular schedules. Adjusters are often called to work in the event of emergencies and may have to work 50 or 60 hours a week until all claims are resolved.
Appraisers spend much of their time offsite at automotive body shops estimating vehicle damage costs. The remaining time may be spent working in the office. Many independent appraisers work from home, as continually improving valuation software has made estimating damage easier and more routine. Auto damage appraisers typically work regular hours, and rarely work on the weekends. Self-employed appraisers also have the flexibility to make their own hours, as many appraisals are done by appointment. Some days, investigators will spend all day in the office, searching databases, making telephone calls, and writing reports. Other times, they may be away, performing surveillance activities or interviewing witnesses. Some of the work can involve disagreements with claimants, so the job can be stressful and potentially confrontational. Insurance investigators often work irregular hours because of the need to conduct surveillance and contact people who are not available during normal working hours. Early morning, evening and weekend work is common.
According to the Bureau of Labor Statistics, employment of insurance adjusters, appraisers, examiners, and investigators is expected to grow 3 percent between 2010 and 2020, slower than the average for all occupations. Employment growth of adjusters and claims examiners will primarily stem from the growth of the health insurance industry. Rising healthcare premiums and attempts by large insurance carriers to minimize costs will result in a greater need for claims examiners to more scrupulously review a growing number of medical claims. More claims being made by a growing elderly population also should spur demand for adjusters and claims examiners. Although technology is reducing the amount of time it takes for an adjuster to complete a claim, thereby increasing the number of claims that one adjuster can handle, demand for these jobs will increase anyway because many tasks cannot be easily automated.
Career information courtesy of the Bureau of Labor Statistics' Occupational Outlook Handbook.