Claims Adjuster

Insurance claims—whether medical, fire, life, homeowner, or vehicle—all need to be reviewed when they come in. Claims Adjuster generally work within the insurance industry, reviewing the information on claims and deciding whether to deny or pay.

The main function of your job as a Claims Adjuster is to protect your company against fraudulent claims. That means if a claim reports $4000 worth of damage from a car accident, you work to ensure that the specifics of the accident fit within the insurance guidelines, that the accident actually occurred, and that the damage happened at the time of the accident rather than before or after.

The job of Claims Adjuster requires attention to detail, and a working knowledge of the industry. Say, for example, you process medical insurance claims. You review the codes entered into the file by Doctors, Nurses, and office staff. If the code refers to treatment for depression, you check to make sure the patient’s policy covers it. If it is not included in the plan, you deny the claim. If it is, you consider deductibles, and compute the amount that is owed to the medical office.

Claims flow across your desk like water. Each one you process is followed by ten more, so you work quickly while maintaining accuracy. You wear your ethical hat and refuse to share confidential information about customers. On top of all that, you also pay strict attention to policy and company guidelines.