Claims Adjuster and Fraud Investigator


This career is expected to grow 7 percent through 2018, about as fast as average. Some companies may try to cut costs by downsizing claims staffs or by streamlining the claims process through technology, but the aging population and the impossibility of fully automating the claims process will ensure continued job growth.
 
College graduates and those with experience will have the best opportunities for jobs as claims adjusters, examiners and investigators. Job outlook is best in the health insurance industry.
 
In 2008, claims adjusters enjoyed an average salary of $55,760. The middle 50 percent earned between $42,400 and $70,860. The highest 10 percent earned more than $73,210.
 
Many claims adjusters receive additional bonuses or benefits as part of their job. They also sometimes get use of laptop computers, cellular phones and/or cars.
 
Adjusters, appraisers, examiners and investigators deal with claims made to insurance companies. They decide whether the customer’s policy covers the loss that he or she is claiming and how much the insurance company should pay.
 
The roles of adjusters, appraisers, examiners and investigators are different but overlapping: Adjusters plan and schedule the work required to process a claim. They interview all the parties involved, gather information, write a report, and negotiate with the claimant to settle the claim.
 
Claims examiners do similar work, but also make sure that all guidelines have been followed in the filing of claims. In health insurance companies, claims examiners review claims to see whether costs are reasonable given the diagnosis.
 
Appraisers estimate the cost or value of an insured item. When adjusters or examiners suspect fraud or criminal activity, they refer the claim to an investigator who can find out whether fraud has occurred.
 
Most employers prefer to hire college grads who hold at least an associate degree. Good majors include insurance, accounting, criminal justice, psychology, forensics, law, legal assisting, security, computer information systems and office management. General management degrees are excellent as they provide a good base for business skills, including writing, record-keeping and reporting.
 
Continuing education is very important for claims adjusters, appraisers, examiners and investigators.
 
Licensing:
Licensing requirements for claims adjusters, appraisers, examiners and investigators vary by state. Examiners and adjusters can also earn professional certifications and designations to demonstrate their professional expertise.
 
Entering the Field:
Beginning claims adjusters, appraisers and examiners work on small claims. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims. Auto damage appraisers may also receive on-the-job training.
 
Career Changers:
These jobs are ideal for career changers from certain backgrounds, including business, accounting, home inspection, engineering technology, legal assisting, criminal justice, probation, insurance sales, medical assisting, or auto body repair.
 
For investigator jobs, most insurance companies prefer to hire people trained as law enforcement officers, private investigators, police officers, loss prevention officers, paralegals and claims adjusters because these workers often have good interviewing and interrogation skills.

 

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Source for salary and growth data is the Bureau of Labor Statistics. For more information on careers in claims adjustment and fraud investigation, salaries, and job prospects visit: U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition, Claims Adjusters, Appraisers, Examiners, and Investigators.

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