Claims Adjusters, Appraisers, Examiners, and Investigators

Summary

claims adjusters appraisers examiners and investigators image
Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims.
Quick Facts: Claims Adjusters, Appraisers, Examiners, and Investigators
2014 Median Pay $62,300 per year
$29.95 per hour
Typical Entry-Level Education See How to Become One
Work Experience in a Related Occupation None
On-the-job Training See How to Become One
Number of Jobs, 2014 315,300
Job Outlook, 2014-24 3% (Slower than average)
Employment Change, 2014-24 9,600

What Claims Adjusters, Appraisers, Examiners, and Investigators Do

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much.

Work Environment

Most claims adjusters, appraisers, examiners, and investigators work full time. They often work outside the office, inspecting properties for which insurance claims have been made, such as damaged buildings and automobiles.

How to Become a Claims Adjuster, Appraiser, Examiner, or Investigator

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Pay

The median annual wage for claims adjusters, appraisers, examiners, and investigators was $62,300 in May 2014.

Job Outlook

Employment of claims adjusters, appraisers, examiners, and investigators is projected to grow 3 percent from 2014 to 2024, slower than the average for all occupations. Demand for these workers is expected to result from growth in the health insurance industry, but should be constrained by automation. In addition, safer automobiles should result in fewer accidents and less demand for auto damage appraisers.

State & Area Data

Explore resources for employment and wages by state and area for claims adjusters, appraisers, examiners, and investigators.

Similar Occupations

Compare the job duties, education, job growth, and pay of claims adjusters, appraisers, examiners, and investigators with similar occupations.

More Information, Including Links to O*NET

Learn more about claims adjusters, appraisers, examiners, and investigators by visiting additional resources, including O*NET, a source on key characteristics of workers and occupations.

What Claims Adjusters, Appraisers, Examiners, and Investigators Do

Claims adjusters, appraisers, examiners, and investigators
Claims adjusters inspect property damage to determine how much the company should pay for the loss.

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim and, if so, how much.

Duties  

Claims adjusters, appraisers, examiners, and investigators typically do the following:

  • Investigate, evaluate, and settle insurance claims
  • Determine whether the insurance policy covers the loss claimed
  • Decide the appropriate amount the insurance company should pay
  • Ensure that claims are not fraudulent
  • Contact claimants’ doctors or employers to get additional information on questionable claims
  • Confer with legal counsel on claims when needed
  • Negotiate settlements
  • Authorize payments

Claims adjusters, appraisers, examiners, and investigators have varying duties, depending on the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable. 

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. They might inspect a home, a business, or an automobile.

Adjusters interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. They may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

Adjusters gather information—including photographs and statements, either written or recorded on audio or video—and put together a report for claims examiners to evaluate. When the examiner approves the claim, the adjuster negotiates with the policyholder and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer’s position.

Some claims adjusters work as self-employed public adjusters. Often, they are hired by claimants who prefer not to rely on the insurance company’s adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant. They are paid a percentage of the settled claim.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure claimants and adjusters followed proper guidelines. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies, to make sure that the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from overstated claims of damage to vehicles to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers’ compensation claim, an investigator may covertly watch the claimant to see if he or she does anything that would be ruled out by injuries stated in the claim.

Work Environment

Claims adjusters, appraisers, examiners, and investigators
Workers who inspect damaged buildings must be wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Claims adjusters, appraisers, examiners, and investigators held about 315,300 jobs in 2014. The industries that employed the most claims adjusters, appraisers, examiners, and investigators were as follows:

Insurance carriers 49%
Agencies, brokerages, and other insurance related activities 24
Federal government 15
State and local government, excluding education and hospitals 4
Management of companies and enterprises 3

Claims adjusters and examiners spend time in offices, reviewing documents and conducting research; they work outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged buildings and automobiles and conducting surveillance. Auto damage appraisers spend much of their time at automotive body shops, estimating vehicle damage costs.

Workers who inspect damaged buildings must be wary of potential hazards, such as collapsed roofs and floors, as well as weakened structures.

Work Schedules

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules vary.

Adjusters often arrange their work schedules to accommodate evening and weekend appointments with clients. This requirement sometimes results in adjusters working irregular schedules, especially when they have a lot of claims to review.  

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends, although they frequently spend much of their time at automotive body shops, estimating vehicle damage costs.

Insurance investigators often work irregular schedules because of the need to conduct surveillance and contact people who are not available during normal business hours. Early morning, evening, and weekend work is common.

How to Become a Claims Adjuster, Appraiser, Examiner, or Investigator

Claims adjusters, appraisers, examiners, and investigators
At the beginning of their careers, claims adjusters, appraisers, examiners, and investigators work on small claims, under the supervision of an experienced worker.

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. Higher level positions may require a bachelor’s degree or some insurance-related work experience. Auto damage appraisers typically have either a postsecondary nondegree award or work experience in identifying and estimating the cost of automotive repair.

Education

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator. However, employers sometimes prefer to hire applicants who have a bachelor’s degree or some insurance-related work experience or vocational training. Auto damage appraisers typically have either a postsecondary nondegree award or experience working in an auto repair shop, identifying and estimating the cost of automotive repair.

The varying types of work in these occupations can require different backgrounds or different college coursework. For example, a business or an accounting background might be best for someone who wishes to specialize in claims of financial loss due to strikes, equipment breakdowns, or merchandise damage. College training in architecture or engineering is helpful for adjusting industrial claims, such as those involving damage from fires or other accidents. A legal background is beneficial to someone handling workers’ compensation and product liability cases. A medical background is useful for examiners working on medical and life insurance claims.

Although auto damage appraisers are not required to have a college education, most companies prefer to hire people who have the formal training, experience, or knowledge and technical skills to identify and estimate the cost of automotive repair. Many vocational schools and some community colleges offer programs in auto body repair and teach students how to estimate the cost of repairing damaged vehicles.

For investigator jobs, a high school diploma or equivalent is the typical education requirement. Most insurance companies prefer to hire people trained as law enforcement officers, private investigators, claims adjusters, or examiners, because these workers have good interviewing and interrogation skills.

Training

At the beginning of their careers, claims adjusters, examiners, and investigators work on small claims, under the supervision of an experienced worker. As they learn more about claims investigation and settlement, they are assigned larger, more complex claims.

Auto damage appraisers typically get on-the-job training, which may last several months. This training usually involves working under the supervision of a more experienced appraiser while estimating damage costs, until the employer decides that the trainee is ready to do estimates on his or her own.

Licenses, Certifications, and Registrations

Licensing requirements for claims adjusters, appraisers, examiners, and investigators vary by state. Some states have few requirements; others require either completing prelicensing education or receiving a satisfactory score on a licensing exam (or both).

In some states, claims adjusters employed by insurance companies do not have to become licensed themselves because they can work under the company license.

Public adjusters may need to meet separate or additional requirements.

Some states that require licensing also require a certain number of continuing education credits per year to renew the license. Federal and state laws and court decisions affect how claims must be handled and what insurance policies can and must cover. Examiners working on life and health claims must stay up to date on new medical procedures and the latest prescription drugs. Examiners working on auto claims must be familiar with new car models and the most recent repair techniques. In order to fulfill their continuing education requirements, workers can attend classes or workshops, write articles for claims publications, or give lectures and presentations.

Important Qualities

Analytical skills. Adjusters and examiners must both evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay. Adjusters must carefully consider various pieces of information to reach a decision.

Communication skills. Claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts. They must know the right questions to ask in order to gather the information they need.

Detail oriented. Adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences.

Interpersonal skills. Adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering. These workers must be understanding, yet firm with their company’s policies.

Math skills. Appraisers must be able to calculate property damage.

Pay

Claims Adjusters, Appraisers, Examiners, and Investigators

Median annual wages, May 2014

Business operations specialists

$63,880

Insurance appraisers, auto damage

$63,420

Claims adjusters, appraisers, examiners, and investigators

$62,300

Claims adjusters, examiners, and investigators

$62,220

Total, all occupations

$35,540

 

The median annual wage for claims adjusters, examiners, and investigators was $62,220 in May 2014. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $37,580, and the highest 10 percent earned more than $92,620.

The median annual wage for insurance appraisers, auto damage was $63,420 in May 2014. The lowest 10 percent earned less than $43,510, and the highest 10 percent earned more than $90,840.

In May 2014, the median annual wages for claims adjusters, appraisers, examiners, and investigators in the top industries in which they worked were as follows:

Federal government $69,740
Management of companies and enterprises 61,500
Insurance carriers 60,910
Agencies, brokerages, and other insurance related activities 58,940
State and local government, excluding education and hospitals 58,310

Most claims adjusters, appraisers, examiners, and investigators work full time. However, their work schedules vary.

Job Outlook

Claims Adjusters, Appraisers, Examiners, and Investigators

Percent change in employment, projected 2014-24

Business operations specialists

7%

Total, all occupations

7%

Claims adjusters, examiners, and investigators

3%

Claims adjusters, appraisers, examiners, and investigators

3%

Insurance appraisers, auto damage

-1%

 

Employment of claims adjusters, appraisers, examiners, and investigators is projected to grow 3 percent from 2014 to 2024, slower than the average for all occupations.

Employment of claims adjusters, examiners, and investigators is projected to grow 3 percent from 2014 to 2024, slower than the average for all occupations. Employment growth should stem primarily from the growth of the health insurance industry. Federal legislation mandating individual coverage may increase the number of health insurance customers, including high-risk individuals who are more likely to file claims. Any such increase is expected, in turn, to increase the demand for claims adjusters to determine which treatments are approved and how much the company will pay.

In addition, rising medical costs may result in a greater need for claims examiners to carefully review a growing number of medical claims. An increase in the number of claims being made by a growing elderly population also should spur demand for health insurance claims adjusters and examiners.

The number of natural disasters, such as floods and fires, influences demand for claims adjusters in property and casualty insurance. Future increases in the number of natural disasters could result in strong employment growth for claims adjusters in the field.

All of the preceding factors will be somewhat offset by automation. Technology allows less complex claims to be processed automatically, freeing adjusters to work on more complex claims. As a result, fewer adjusters are needed per claim, reducing the number of adjusters required on staff.

Employment of auto damage appraisers is projected to decline 1 percent from 2014 to 2024. In recent years, the number of automobile accidents relative to the population has declined. As automobiles become safer, the number of traffic accidents is expected to decline as well, leading to decreased demand for the services of auto damage appraisers.  

Job Prospects

Job opportunities for claims adjusters and examiners should be best in the health insurance industry as the number of health insurance customers expands. In addition, prospects for claims adjusters in property and casualty insurance will likely be best in areas susceptible to natural disasters. These areas include the Gulf Coast, which can have a large number of hurricanes, and the West Coast, which is vulnerable to wildfires.

Employment projections data for claims adjusters, appraisers, examiners, and investigators, 2014-24
Occupational Title SOC Code Employment, 2014 Projected Employment, 2024 Change, 2014-24 Employment by Industry
Percent Numeric

SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program

Claims adjusters, appraisers, examiners, and investigators

13-1030 315,300 324,900 3 9,600 [XLSX]

Claims adjusters, examiners, and investigators

13-1031 299,700 309,500 3 9,800 [XLSX]

Insurance appraisers, auto damage

13-1032 15,500 15,400 -1 -200 [XLSX]

State & Area Data

Occupational Employment Statistics (OES)

The Occupational Employment Statistics (OES) program produces employment and wage estimates annually for over 800 occupations. These estimates are available for the nation as a whole, for individual states, and for metropolitan and nonmetropolitan areas. The link(s) below go to OES data maps for employment and wages by state and area.

Projections Central

Occupational employment projections are developed for all states by Labor Market Information (LMI) or individual state Employment Projections offices. All state projections data are available at www.projectionscentral.com. Information on this site allows projected employment growth for an occupation to be compared among states or to be compared within one state. In addition, states may produce projections for areas; there are links to each state’s websites where these data may be retrieved.

Career InfoNet

America’s Career InfoNet includes hundreds of occupational profiles with data available by state and metro area. There are links in the left-hand side menu to compare occupational employment by state and occupational wages by local area or metro area. There is also a salary info tool to search for wages by zip code.

Similar Occupations

This table shows a list of occupations with job duties that are similar to those of claims adjusters, appraisers, examiners, and investigators.

Occupation Job Duties ENTRY-LEVEL EDUCATION 2014 MEDIAN PAY
Appraisers and assessors of real estate

Appraisers and Assessors of Real Estate

Appraisers and assessors of real estate provide an estimate of the value of land and the buildings on the land usually before it is sold, mortgaged, taxed, insured, or developed.

Bachelor's degree $52,570
Automotive body and glass repairers

Automotive Body and Glass Repairers

Automotive body and glass repairers restore, refinish, and replace vehicle bodies and frames, windshields, and window glass.

High school diploma or equivalent $39,260
Automotive service technicians and mechanics

Automotive Service Technicians and Mechanics

Automotive service technicians and mechanics, often called service technicians or service techs, inspect, maintain, and repair cars and light trucks.

Postsecondary nondegree award $37,120
Construction and building inspectors

Construction and Building Inspectors

Construction and building inspectors ensure that construction meets local and national building codes and ordinances, zoning regulations, and contract specifications.

High school diploma or equivalent $56,040
Cost estimators

Cost Estimators

Cost estimators collect and analyze data in order to estimate the time, money, materials, and labor required to manufacture a product, construct a building, or provide a service. They generally specialize in a particular product or industry.

Bachelor's degree $60,050
Fire inspectors and investigators

Fire Inspectors

Fire inspectors examine buildings to detect fire hazards and ensure that federal, state, and local fire codes are met. Fire investigators determine the origin and cause of fires and explosions. Forest fire inspectors and prevention specialists assess fire hazards in both public and residential areas.

See How to Become One $54,020
Suggested citation:

Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2016-17 Edition, Claims Adjusters, Appraisers, Examiners, and Investigators,
on the Internet at http://www.bls.gov/ooh/business-and-financial/claims-adjusters-appraisers-examiners-and-investigators.htm (visited February 10, 2016).

Publish Date: Thursday, December 17, 2015