Claims Adjuster job description
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What does a Claims Adjuster do?
The Claims Adjuster is responsible for investigating, evaluating, and negotiating insurance claims. This role ensures fair, timely, and efficient claims settlement in alignment with company policies and regulatory requirements, contributing to customer satisfaction and operational efficiency.
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What are the Key Responsibilities of Claims Adjuster
- Investigate and analyze insurance claims by reviewing submitted documentation and conducting interviews as necessary.
- Determine the validity and value of claims based on insurance policies and applicable laws.
- Negotiate settlements with clients or attorneys to reach amicable solutions.
- Prepare detailed reports that provide an overview of claim reviews and settlements.
- Coordinate with external experts, such as medical professionals or repair specialists, when needed.
- Maintain accurate and transparent documentation of all case-related activities.
- Provide recommendations on disputed or complex claims for management review.
What are the Skills and Requirements for a Claims Adjuster?
- Proficient in independent claims investigation and evaluation.
- Excellent negotiation and interpersonal skills.
- Detail-oriented with strong analytical problem-solving abilities.
- Ability to manage multiple tasks effectively under tight deadlines.
- Sound judgment in decision-making related to settlements.
What are the KPIs to track for Claims Adjuster?
The Claims Adjuster's performance is gauged by the accuracy and speed of claims processing, customer satisfaction scores post-claim resolution, and adherence to regulatory compliance.
Claims Processing Efficiency
Average turnaround time for processing claims.
Customer Satisfaction
Customer satisfaction rate following claims resolution.
Compliance Adherence
Number of compliance issues reported or resolved.
Reports to
Claims Manager
Collaborates with
Legal Team, Underwriters
Leads
Claims Assistants
Are any specific tools or software required for the Claims Adjuster role?
- Claims management software
- Microsoft Office Suite
- Xactimate
What is the qualification of Claims Adjuster?
Bachelor's degree in Finance, Business Administration, or a related field; CPCU or related certification preferred; 3-5 years of experience in claims adjustment.
