A claims adjuster plays a vital role in the insurance industry, acting as the key intermediary between policyholders and insurance companies. They are responsible for investigating insurance claims, assessing damages, and determining the extent of the insurer’s liability.
This position requires a keen eye for detail, strong analytical skills, and a commitment to resolving claims efficiently and fairly. Whether you are an employer seeking to attract top talent or a candidate looking to understand the role better, this claims adjuster job description template provides clear insights into the key responsibilities and qualifications needed.
In the following sections, we’ll explore the essential functions of a claims adjuster as well as the skills that are critical for success in this position.
Claims adjusters are tasked with a variety of responsibilities that ensure the claims process runs smoothly.
1. Investigating claims by reviewing information from policyholders, witnesses, and other sources.
2. Evaluating damages and determining an appropriate amount for compensation based on policy terms and conditions.
3. Writing detailed reports to document findings and make recommendations on claims approval or denial.
4. Communicating with policyholders, attorneys, and medical professionals to gather necessary information.
5. Negotiating settlements with claimants based on the evaluation of the claim.
6. Maintaining thorough records of claims processes and decisions made.
7. Staying updated on state regulations and company policies regarding insurance claims.
To excel as a claims adjuster, specific qualifications and skills are crucial.
1. Education: A high school diploma is typically required, though a bachelor’s degree in finance, insurance, or a related field is often preferred.
2. Licensing: Many states require claims adjusters to hold a state license, necessitating training and examination.
3. Experience: Previous experience in a similar role or in the insurance industry can be advantageous.
4. Analytical Skills: The ability to analyze information critically and make sound judgments is essential.
5. Communication Skills: Effective written and verbal communication skills are necessary for discussing claims with various stakeholders.
6. Negotiation Skills: Strong negotiation skills are important for reaching amicable settlements in claims.
Claims adjusters usually work in an office setting but may also spend time visiting claim sites. This role can be fast-paced, especially during peak claim periods, and may require flexibility in working hours.
Interaction with clients and other stakeholders is frequent, making strong interpersonal skills essential.
Claims adjusters may have opportunities for career advancement by taking on more complex claims, specializing in particular areas of insurance, or moving into supervisory roles. Continuing education and additional certifications, such as those offered by the International Association of Claims Professionals (IACP), can also pave the way for career growth in the field.
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Key Responsibilities
### Primary duties (daily and highest priority)
- •Investigate and document claims (daily): Interview policyholders and witnesses, collect police reports and photos, and complete on-site inspections. Accurate documentation reduces litigation risk and speeds settlement — aim to close 60–80% of straightforward claims within 30 days.
- •Evaluate coverage and determine liability (daily): Review policy language, endorsements, and exclusions to determine payability. Correct coverage determination prevents overpayments and maintains loss ratio targets (typically 60–70% for property lines).
- •Estimate and set reserves (daily/weekly): Use estimating tools (e.g., Xactimate) to size damage and set initial reserves within ±10% of expected payout. Update reserves after major milestones to protect company capital.
- •Negotiate settlements (weekly): Present offers, negotiate with claimants and attorneys, and finalize agreements. Close settlements that meet profitability and customer-satisfaction targets (e.g., >85% satisfaction).
- •Coordinate repairs and vendor work (weekly): Schedule contractors, order temporary repairs, and approve invoices. Manage vendor relationships to control cycle time and reduce rework by 15–25%.
- •Fraud detection and escalation (ongoing): Flag suspicious patterns, run data checks, and refer to SIU when needed. Early detection saves an estimated 5–12% in improper payments.
- •Caseload and workflow management (daily/weekly): Maintain an active caseload (entry-level 50–80 files; experienced 80–150) and meet KPIs: average days to close, reserve accuracy, and contact frequency.
- •Strategic analysis and process improvement (monthly/quarterly): Analyze claim trends (e.g., frequency by ZIP code), propose process changes, and participate in CAT response planning to reduce recovery time.
Actionable takeaway: Prioritize timely investigations, keep reserves updated, and document decisions clearly to reduce cycle time and financial exposure.
Required Qualifications
### Technical skills
- •Adjusting software (must): Proficiency in Xactimate, CCC, or Guidewire ClaimsCenter for estimates and file notes. These tools speed estimates by 30–50%.
- •Inspection tools (must): Use mobile apps and drones for rapid property assessment; capture geo-tagged photos and measurements.
- •Regulatory knowledge (must): Familiarity with state insurance codes and P&C principles ensures compliant settlements.
- •Medical and auto basics (nice-to-have): Understanding medical billing codes or auto repair terminology improves negotiation accuracy.
### Soft skills
- •Clear communication (must): Explain coverage and next steps to claimants; written notes must be concise and defendable in audits.
- •Negotiation and conflict resolution (must): Close settlements while protecting company loss ratios; target a 70–90% first-offer success in routine files.
- •Attention to detail (must): Spot exclusions, inconsistencies, and small damages to avoid downstream costs.
- •Time management (must): Handle a caseload of 50–150 files and prioritize CAT work under pressure.
### Education and certifications
- •Minimum education (must): High school diploma or GED; bachelor’s in risk management, business, or construction preferred.
- •Licenses (must): State adjuster license where required; maintain continuing education (typically 24–40 hrs/yr).
- •Professional credentials (nice-to-have): AIC, CPCU, or ARM for career advancement and technical depth.
### Experience requirements
- •Entry-level (0–2 years): Experience with customer service or construction helpful; supervised training on estimating software.
- •Mid-level (3–5 years): Proven record handling 75+ claims/month and closing within target cycle times.
- •Senior (5+ years): Complex/liability or CAT experience, mentor junior staff, and referral authority for litigation.
Actionable takeaway: Prioritize obtaining a state adjuster license and hands-on estimating software practice; aim for one industry certification within two years.