Claims Adjusters, Appraisers, Examiners, and Investigators

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
• Talk with legal counsel about 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 so that they can 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 or personal injury claims 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 review. 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 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.

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 make sure claimants and adjusters followed proper guidelines. They may help adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

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 vehicle damage 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 suspicious based on injuries stated in the claim.

Claims adjusters, examiners, and investigators held about 356,100 jobs in 2024. The largest employers of claims adjusters, examiners, and investigators were as follows:

Insurance appraisers, auto damage held about 9,200 jobs in 2024. The largest employers of insurance appraisers, auto damage were as follows:

Claims adjusters and examiners work in offices when reviewing documents and conducting research. They work outside when examining damaged property. Appraisers and investigators work outside more often, inspecting damaged automobiles and buildings 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 careful around 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 may 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.

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

In contrast, auto damage appraisers typically work regular hours and rarely work on weekends.

A high school diploma or equivalent is typically required for a person to work as an entry-level claims adjuster, examiner, or investigator, although some positions need a bachelor’s degree or 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.

The median annual wage for claims adjusters, examiners, and investigators was $76,790 in May 2024.

The median annual wage for insurance appraisers, auto damage was $76,650 in May 2024.

Overall employment of claims adjusters, appraisers, examiners, and investigators is projected to grow 5 percent from 2024 to 2034, decline.

About 21,600 openings for claims adjusters, appraisers, examiners, and investigators are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.