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Claims Adjusters, Examiners, and Investigators
(SOC Code : 13-1031)
in California

Review settled claims to determine that payments and settlements have been made in accordance with company practices and procedures, ensuring that proper methods have been followed. Report overpayments, underpayments, and other irregularities. Confer with legal counsel on claims requiring litigation.

Employers usually expect an employee in this occupation to be able to do the job after Long-term on-the-job training (> 12 months) .
Occupational Wages[Top]
AreaYearPeriodHourly MeanHourly by Percentile
25thMedian75th
California 20231st Qtr$39.44$30.81$39.05$47.28

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Occupational Projections of Employment (also called "Outlook" or "Demand")[Top]
Projections for this occupation in California are not available.

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Possible Licenses Required and Issuing Authority[Top]
License Title
License Authority
Adjuster, Interim Public InsuranceDepartment of Insurance
Producer Licensing Bureau
http://www.insurance.ca.gov
Adjuster, Public InsuranceDepartment of Insurance
Producer Licensing Bureau
http://www.insurance.ca.gov
Adjuster, Independent InsuranceDepartment of Insurance
Producer Licensing Bureau
http://www.insurance.ca.gov

About Licenses
 
Industries Employing This Occupation (click on Industry Title to View Employers List)[Top]
Industry Title
Number of Employers in State of California
Percent of Total
Employment for Occupation in State of California
Insurance Carriers88535.0%
Agencies, Broker and Other Insur23,64424.5%
Management of Companies and Enterpri5,3544.7%
Office Administrative Services 5,5732.9%
Employment Services5,1101.5%
Offices of Physicians 59,0671.2%

About Staffing Patterns
 
Training Programs (click on title for more information)[Top]
Program Title
Health/Medical Claims Examiner
Insurance

About Training & Apprenticeships
 
About This Occupation (from O*NET - The Occupation Information Network)[Top]
Top Tasks (Specific duties and responsibilities of this job.)
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.
Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
Resolve complex, severe exposure claims, using high service oriented file handling.
Pay and process claims within designated authority level.
Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
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.
Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
Confer with legal counsel on claims requiring litigation.
Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
Maintain claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

More Tasks for Claims Adjusters, Examiners, and Investigators , More Tasks for Claims Examiners, Property and Casualty Insurance , More Tasks for Insurance Adjusters, Examiners, and Investigators

Top Skills used in this Job
Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
Reading Comprehension - Understanding written sentences and paragraphs in work related documents.
Writing - Communicating effectively in writing as appropriate for the needs of the audience.
Speaking - Talking to others to convey information effectively.
Active Listening - Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Critical Thinking - Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Speaking - Talking to others to convey information effectively.
Negotiation - Bringing others together and trying to reconcile differences.

More Skills for Claims Adjusters, Examiners, and Investigators , More Skills for Claims Examiners, Property and Casualty Insurance , More Skills for Insurance Adjusters, Examiners, and Investigators

Top Abilities (Attributes of the person that influence performance in this job.)
Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences.
Written Comprehension - The ability to read and understand information and ideas presented in writing.
Oral Expression - The ability to communicate information and ideas in speaking so others will understand.
Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences.
Written Comprehension - The ability to read and understand information and ideas presented in writing.
Oral Expression - The ability to communicate information and ideas in speaking so others will understand.
Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
Inductive Reasoning - The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).

More Abilities for Claims Adjusters, Examiners, and Investigators , More Abilities for Claims Examiners, Property and Casualty Insurance , More Abilities for Insurance Adjusters, Examiners, and Investigators

Top Work Values (Aspects of this job that create satisfaction.)
Support - Occupations that satisfy this work value offer supportive management that stands behind employees.
Independence - Occupations that satisfy this work value allow employees to work on their own and make decisions.

More WorkValues for Claims Adjusters, Examiners, and Investigators , More WorkValues for Claims Examiners, Property and Casualty Insurance , More WorkValues for Insurance Adjusters, Examiners, and Investigators

Top Interests (The types of activities someone in this job would like.)
Conventional - Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
Enterprising - Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.

More Interests for Claims Adjusters, Examiners, and Investigators , More Interests for Claims Examiners, Property and Casualty Insurance , More Interests for Insurance Adjusters, Examiners, and Investigators

Alternate Titles
Appraisers; Claims Agents; Claims Analysts; Claims Representatives; Claims Specialists; Customer Care Specialists; Field Adjusters; Health Insurance Adjusters; Insurance Appraisers; Insurance Auditors; Litigation Examiners; Workers' Compensation Examiners
 
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