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What Claims Adjusters, Appraisers, Examiners, and Investigators Do About this section

Claims adjusters, appraisers, examiners, and investigators
Claims adjusters inspect property damage to determine how much the company should pay for the loss.

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and if so, how much.

Duties

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants’ doctors or employers to get additional information on questionable claims
  • Confer with legal counsel on claims when needed
  • Negotiate settlements
  • Authorize payments

Claims adjusters, appraisers, examiners, and investigators have varying duties, depending on the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs in order to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable.

Adjusters inspect property damage or personal injury claims to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile.

Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. They may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

Adjusters gather information—including photographs and statements, either written or recorded on audio or video—and put together a report for claims examiners to evaluate. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer’s position.

Some claims adjusters work as public adjusters. Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant. They are paid a percentage of the settled claim.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure claimants and adjusters followed proper guidelines. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from overstated claims of damage to vehicles to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does anything that would be suspicious based on injuries stated in the claim.

Work Environment About this section

Claims adjusters, appraisers, examiners, and investigators
Workers who inspect damaged buildings must be wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Claims adjusters, examiners, and investigators held about 332,900 jobs in 2019. The largest employers of claims adjusters, examiners, and investigators were as follows:

Direct insurance (except life, health, and medical) carriers 30%
Agencies, brokerages, and other insurance related activities 27
Government 18
Direct health and medical insurance carriers 9
Administrative and support services 2

Insurance appraisers, auto damage held about 15,900 jobs in 2019. The largest employers of insurance appraisers, auto damage were as follows:

Agencies, brokerages, and other insurance related activities 28%
Self-employed workers 3
Management of companies and enterprises 1
Professional, scientific, and technical services 0

Claims adjusters and examiners spend time in offices reviewing documents and conducting research. They work outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged buildings and automobiles and conducting surveillance. Auto damage appraisers spend much of their time at automotive body shops estimating vehicle damage costs.

Workers who inspect damaged buildings must be wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Work Schedules

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.

Insurance investigators often work irregular schedules because of the need to conduct surveillance and contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

How to Become a Claims Adjuster, Appraiser, Examiner, or Investigator About this section

Claims adjusters, appraisers, examiners, and investigators
At the beginning of their careers, claims adjusters, appraisers, examiners, and investigators work on small claims, under the supervision of an experienced worker.

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator, although some positions may require a bachelor’s degree or insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or previous work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster or examiner. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Some insurance companies prefer to hire people trained as law enforcement officers or private investigators, because these workers have good interviewing and interrogation skills.

Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

Pay About this section

Claims Adjusters, Appraisers, Examiners, and Investigators

Median annual wages, May 2019

Business operations specialists

$68,730

Claims adjusters, examiners, and investigators

$66,790

Claims adjusters, appraisers, examiners, and investigators

$66,540

Insurance appraisers, auto damage

$63,270

Total, all occupations

$39,810

 

The median annual wage for claims adjusters, examiners, and investigators was $66,790 in May 2019. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $41,100, and the highest 10 percent earned more than $100,400.

The median annual wage for insurance appraisers, auto damage was $63,270 in May 2019. The lowest 10 percent earned less than $44,430, and the highest 10 percent earned more than $93,720.

In May 2019, the median annual wages for claims adjusters, examiners, and investigators in the top industries in which they worked were as follows:

Government $73,470
Direct insurance (except life, health, and medical) carriers 66,690
Agencies, brokerages, and other insurance related activities 64,890
Administrative and support services 60,450
Direct health and medical insurance carriers 58,560

In May 2019, the median annual wages for insurance appraisers, auto damage in the top industries in which they worked were as follows:

Management of companies and enterprises $63,690
Professional, scientific, and technical services 61,440
Agencies, brokerages, and other insurance related activities 61,060

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.

Insurance investigators often work irregular schedules because of the need to conduct surveillance and contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

Job Outlook About this section

Claims Adjusters, Appraisers, Examiners, and Investigators

Percent change in employment, projected 2019-29

Business operations specialists

6%

Total, all occupations

4%

Insurance appraisers, auto damage

-4%

Claims adjusters, appraisers, examiners, and investigators

-6%

Claims adjusters, examiners, and investigators

-6%

 

Overall employment of claims adjusters, appraisers, examiners, and investigators is projected to decline 6 percent from 2019 to 2029.

Technology is expected to automate some of the tasks currently performed by these workers. For example, computer software can evaluate photographs of damaged property and calculate an estimated claim amount. In addition, data collection and processing speed will increase, which will improve efficiency and make workers more productive.

Demand for these workers should stem primarily from the growth of the health insurance industry. Rising medical costs may result in a greater need for claims examiners to carefully review a growing number of medical claims. An increase in the number of claims being made by a growing elderly population also should spur demand for health insurance claims adjusters and examiners.

The number of natural disasters, such as floods and fires, influences demand for claims adjusters in property and casualty insurance. Future increases in the number of natural disasters could result in some employment growth for claims adjusters in the field.

Job Prospects

Job opportunities for claims adjusters and examiners should be best in firms providing services related to insurance, such as insurance claims adjusting companies. In addition, prospects for claims adjusters in property and casualty insurance will likely be best in areas susceptible to natural disasters. These areas include the Gulf Coast, which can have a large number of hurricanes, and the West Coast, which is vulnerable to wildfires.

As technology continues to affect this work, those who are familiar and comfortable with computers and information technology should also have better prospects.

Employment projections data for claims adjusters, appraisers, examiners, and investigators, 2019-29
Occupational Title SOC Code Employment, 2019 Projected Employment, 2029 Change, 2019-29 Employment by Industry
Percent Numeric

SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program

Claims adjusters, appraisers, examiners, and investigators

13-1030 348,800 326,800 -6 -22,000 Get data

Claims adjusters, examiners, and investigators

13-1031 332,900 311,500 -6 -21,400 Get data

Insurance appraisers, auto damage

13-1032 15,900 15,300 -4 -600 Get data

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