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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. Show Details

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
  • Keep claims files, such as records of settled claims and an inventory of claims requiring detailed analysis
  • Negotiate settlements
  • Authorize payments

What insurance adjusters, examiners, and investigators do varies by 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. 

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.

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.

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. The property they inspect could be a home, a business, or an automobile.

They interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. Adjusters 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.

They gather information—including photographs and statements, either written or recorded audio or video—and put it in a report that claims examiners use to evaluate the claim. When the examiner approves policyholder's claim, the claims adjuster negotiates with the claimant 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.

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 that proper guidelines have been followed by claimants and adjusters. 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 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 claimants overstating 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 activities that would be ruled out by injuries stated in the claim.

Construction Managers

Construction managers plan, coordinate, budget, and supervise construction projects from early development to completion. Show Details

Duties

Construction managers typically do the following:

  • Prepare and negotiate cost estimates, budgets, and work timetables
  • Select appropriate construction methods and strategies
  • Interpret and explain contracts and technical information to workers and other professionals
  • Report on work progress and budget matters to clients
  • Collaborate with architects, engineers, and other construction and building specialists
  • Instruct and supervise construction personnel and activities onsite
  • Respond to work delays and other problems and emergencies
  • Select, hire, and instruct laborers and subcontractors  
  • Comply with legal requirements, building and safety codes, and other regulations

Construction managers, often called general contractors or project managers, coordinate and supervise a wide variety of projects, including the building of all types of residential, commercial, and industrial structures, roads, bridges, powerplants, schools, and hospitals. They oversee specialized contractors and other personnel. Construction managers schedule and coordinate all design and construction processes to ensure a productive and safe work environment. They also make sure jobs are completed on time and on budget with the right amount of tools, equipment, and materials. Many managers also are responsible for obtaining necessary permits and licenses. They are often responsible for multiple projects at a time.

Construction managers work closely with other building specialists, such as architects, engineers, and a variety of trade workers, such as stonemasons, electricians, and carpenters. Projects may require specialists in everything from structural metalworking and painting, to landscaping, building roads, installing carpets, and excavating sites. Depending on the project, construction managers also may interact with lawyers and local government officials. For example, when working on city-owned property or municipal buildings, managers sometimes confer with city council members to ensure that all regulations are met.

For projects too large to be managed by one person, such as office buildings and industrial complexes, a construction manager would only be in charge of one part of the project. Each construction manager would oversee a specific construction phase and choose subcontractors to complete it. Construction managers may need to collaborate and coordinate with other construction managers who are responsible for different aspects of the project.

To maximize efficiency and productivity, construction managers often use specialized cost-estimating and planning software to effectively budget the time and money required to complete specific projects. Many managers also use software to determine the best way to get materials to the building site. For more information, see the profile on cost estimators.

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