Description
Loss adjusters treat and evaluate insurance claims by investigating the cases and determining liability and damage, in accordance with the policies of the insurance company. They interview the claimant and witnesses and write reports for the insurer where appropriate recommendations for the settlement are made. Loss adjusters’ tasks include making payments to the insured following his claim, consulting damage experts and providing information via telephone to the clients.
Duties
Loss adjusters typically do the following:
- visit sites to survey damage
- interview customers
- gather evidence, like security camera footage or police reports
- request reports from specialists, like building surveyors
- check that claims against policies are reasonable
- organise clean-up operations or building repairs
- make further investigations if you suspect fraud
- give evidence in court
- present reports and recommendations to insurers
Other titles
The following job titles also refer to loss adjuster:
automobile claims technical adjuster
material damage appraiser
vehicle damage appraiser
commercial adjuster
field claims adjuster
motor claims adjuster
insurance loss adjuster
fire claims adjuster
field appraiser
physical damage appraiser
chartered loss adjuster
claims adjusters supervisor
claims adjuster
damage appraiser
civil claims adjuster
automobile appraiser
insurance appraiser
personal claims adjuster
insurance claims adjudicator
domestic adjuster
Minimum qualifications
A bachelor’s degree in business studies, finance, law, surveying, construction, or a related field is recommended to work as a loss adjuster, depending on the area of expertise. A solid experience in a similar entry-level role, such as loss adjusting assistant, is an asset. It is also possible to get to this role through apprenticeship, or by starting
ISCO skill level
ISCO skill level is defined as a function of the complexity and range of tasks and duties to be performed in an occupation. It is measured on a scale from 1 to 4, with 1 the lowest level and 4 the highest, by considering:
- the nature of the work performed in an occupation in relation to the characteristic tasks and duties
- the level of formal education required for competent performance of the tasks and duties involved and
- the amount of informal on-the-job training and/or previous experience in a related occupation required for competent performance of these tasks and duties.
Loss adjuster is a Skill level 3 occupation.
Loss adjuster career path
Similar occupations
These occupations, although different, require a lot of knowledge and skills similar to loss adjuster.
insurance fraud investigator
insurance claims handler
property insurance underwriter
insurance risk consultant
insurance underwriter
Long term prospects
These occupations require some skills and knowledge of loss adjuster. They also require other skills and knowledge, but at a higher ISCO skill level, meaning these occupations are accessible from a position of loss adjuster with a significant experience and/or extensive training.
insurance claims manager
insurance rating analyst
actuarial consultant
insurance agency manager
insurance product manager
Essential knowledge and skills
Essential knowledge
This knowledge should be acquired through learning to fulfill the role of loss adjuster.
- Insurance law: The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.
- Principles of insurance: Understand the principles of insurance, including third party liability, stock and facilities.
- Actuarial science: The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.
- Claims procedures: The different procedures that are used to formally request a payment for a suffered loss from an insurance company.
- Types of insurance: The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.
Essential skills and competences
These skills are necessary for the role of loss adjuster.
- Manage claim files: Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.
- Analyse claim files: Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.
- Present evidence: Present evidence in a criminal or civil case to others, in a convincing and appropriate manner, in order to reach the right or most beneficial solution.
- Compile appraisal reports: Compile full reports of appraisals of properties, businesses, or other goods and services being appraised using all the data gathered during the appraisal and valuation process, such as financial history, ownership, and developments.
- Review insurance process: Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.
- Initiate claim file: Start the process to file a claim for a customer or victim, based on the judgement of the damage and the responsibilities of the parties involved.
- Document evidence: Document all evidence found on a crime scene, during an investigation, or when presented in a hearing, in a manner compliant with regulations, to ensure that no piece of evidence is left out of the case and that records are maintained.
- Check for damaged items: Identify products that have been damaged and report the situation.
- Handle incoming insurance claims: Manage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the circumstances.
- Propose settlements: Take into account the damage appraisal or incident and injury reports in order to suggest a settlement to insurance professionals which would settle the claim with the claimant, such as estimating repair costs for damages or a reimbursement of medical costs.
- Manage claims process: Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.
- Estimate damage: Estimate damage in case of accidents or natural disasters.
- Negotiate settlements: Negotiate with insurance companies and insurance claimants in order to facilitate agreement on a settlement which the insurance company has to provide for the claimant, such as covering repair costs for damages, taking into account the appraisal reports and the coverage assessment.
- Assess coverage possibilities: Examine the reports dealing with damage appraisal or injury examination in order to verify whether the insured’s damages or injuries are covered in their insurance policies, and if they are to assess to which extent they are covered and what settlements the insurer may have to provide.
- Interview insurance claimants: Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.
- Organise a damage assessment: Organise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.
Optional knowledge and skills
Optional knowledge
This knowledge is sometimes, but not always, required for the role of loss adjuster. However, mastering this knowledge allows you to have more opportunities for career development.
- Fraud detection: The techniques used to identify fraudulent activities.
Optional skills and competences
These skills and competences are sometimes, but not always, required for the role of loss adjuster. However, mastering these skills and competences allows you to have more opportunities for career development.
- Collect property financial information: Collect information concerning the previous transactions involving the property, such as the prices at which the property had been previously sold and the costs that went into renovations and repairs, in order to obtain a clear image of the property’s value.
- Investigate occupational injuries: Assess, manage, and report cases of occupational illness, disease, or injury, establishing if this is a single case or if there is wider incidence.
- Prepare financial auditing reports: Compile information on audit findings of financial statements and financial management in order to prepare reports, point out improvement possibilities, and confirm governability.
- Create a financial plan: Develop a financial plan according to financial and client regulations, including an investor profile, financial advice, and negotiation and transaction plans.
- Create cooperation modalities: Prepare, determine and agree on the conditions for cooperation contracts with a company, by comparing products, following evolutions or shifts in the market and negotiating terms and prices.
- Obtain financial information: Gather information on securities, market conditions, governmental regulations and the financial situation, goals and needs of clients or companies.
- Advise on insurance policies: Advise on specific contracts and general insurance guidelines, such as the terms of coverage, the risks that are involved, the handling of claims, and terms of settlements.
- Conduct financial audits: Evaluate and monitor the financial health, the operations and financial movements expressed in the financial statements of the company. Revise the financial records to ensure stewardship and governability.
- Provide information on properties: Provide information on the positive and negative aspects of a property and the practicalities concerning any financial transactions or insurance procedures; such as location, composition of the property, renovation or repair needs, the cost of the property and the costs related to insurance.
- Listen to the stories of the disputants: Listen to the arguments of the parties involved in disputes in order to clarify misunderstandings and miscommunications among them.
- Ensure cross-department cooperation: Guarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.
- Identify damage to buildings: Monitor the state of building exteriors in order to identify any possible damage and to assess the nature of the damage and treatment methods.
- Assess customer credibility: Communicate with customers to assess whether their true intentions are in line with what they claim in order to eliminate any risks from a potential agreement with the customer.
- Determine cause of damage: Recognise damage and signs of corrosion, identify their cause and determine maintenance and repair procedures.
- Analyse financial risk: Identify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.
- Classify insurance claims: Process incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handling, and to guarantee that the claim may proceed to the correct loss adjuster or other claims professionals.
- Manage contract disputes: Monitor issues that arise between the parties involved in a contract and provide solutions in order to avoid lawsuits.
ISCO group and title
3315 – Valuers and loss assessors
References
- Loss adjuster – ESCO
- Insurance loss adjuster | Explore careers – National Careers Service
- Loss Adjuster | Insurance Careers