Investigate, analyze, and determine the extent of insurance company’s liability concerning personal, casualty, or property loss or damages, and attempt to effect settlement with claimants. Correspond with or interview medical specialists, agents, witnesses, or claimants to compile information. Calculate benefit payments and approve payment of claims within a certain monetary limit.
- Examine claims forms and other records to determine insurance coverage.
- Investigate and assess damage to property and create or review property damage estimates.
- Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- Negotiate claim settlements and recommend litigation when settlement cannot be negotiated.
- Analyze information gathered by investigation, and report findings and recommendations.
- Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- Prepare report of findings of investigation.
- Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- Collect evidence to support contested claims in court.
- 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.
- Judgment and Decision Making — Considering the relative costs and benefits of potential actions to choose the most appropriate one.
- Social Perceptiveness — Being aware of others' reactions and understanding why they react as they do.
- Complex Problem Solving — Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Technology used in this occupation:
- Analytical or scientific software — Injury Sciences EDR InSight; Insurance claims fraud detection software; Magnify Predictive Targeting System
- Computer aided design CAD software — 4n6xprt Systems StiffCalcs; ARSoftware WinSMAC; MapScenes Evidence Recorder; Visual Statement Investigator Suite
- Document management software — Agency Management Systems AMS 360; atGlobal Allegro; BCCORP Burkitt W5; InSystems Calligo Document Management System
- Title: Job Zone Three: Medium Preparation Needed
- Education: Most occupations in this zone require training in vocational schools, related on-the-job experience, or an associate's degree.
- Related Experience: Previous work-related skill, knowledge, or experience is required for these occupations. For example, an electrician must have completed three or four years of apprenticeship or several years of vocational training, and often must have passed a licensing exam, in order to perform the job.
- Job Training: Employees in these occupations usually need one or two years of training involving both on-the-job experience and informal training with experienced workers. A recognized apprenticeship program may be associated with these occupations.
- Job Zone Examples: These occupations usually involve using communication and organizational skills to coordinate, supervise, manage, or train others to accomplish goals. Examples include food service managers, electricians, agricultural technicians, legal secretaries, interviewers, and insurance sales agents.
- Specific Vocational Preparation in years: (6.0 to < 7.0)