Claims Examiner vs. Adjuster: What Are the Differences?

A career in insurance can be both challenging and rewarding. Two common positions in this field are that of a claims examiner and an adjuster. Though these positions share some similarities, there are several key differences between them.

In this article, we discuss the differences between a claims examiner and an adjuster, and we provide additional insurance professions you may be interested in pursuing.

What is a Claims Examiner?

A Claims Examiner is responsible for reviewing insurance claims and related documents to determine if the insurance company should approve the claim or deny it. They may also be responsible for investigating claims to determine if they are valid. Claims Examiners typically work in the claims department of an insurance company, but they may also work for a self-insured company or the government. They use their knowledge of the insurance policy and the law to make decisions about whether to approve or deny claims. Claims Examiners must be able to effectively communicate their decisions to claimants.

What is an Adjuster?

An Adjuster is a professional who investigates insurance claims to determine the extent of the insurer’s liability. They gather information about the claim and may interview the insured, witnesses and other parties to get a clear picture of what happened. Adjusters also review police reports, medical records and other documentation to assess the damage and determine the value of the claim. Based on their findings, they negotiate with the parties involved to reach a fair settlement. Adjusters work for insurance companies, self-insured organizations or third-party adjusting firms.

Claims Examiner vs. Adjuster

Here are the main differences between a claims examiner and an adjuster.

Job Duties

Claims examiners and adjusters share some job duties, such as investigating insurance claims. Claims examiners typically perform administrative tasks related to an insurance claim, such as gathering information from the claimant and determining whether the claim meets the requirements for payment.

Adjusters often perform similar tasks when investigating a claim, but they also determine the amount of monetary damages that the claimant suffered. In doing so, they may interview the claimant and any witnesses and evaluate evidence, such as photographs or medical records.

Another key difference between claims examiners and adjusters is their level of decision-making authority. Because claims examiners work in an administrative role, they rarely make decisions about a claim. Instead, they communicate the findings of their investigation to their supervisor, who makes the final decision about the claim.

Job Requirements

Most insurance companies require claims examiners and adjusters to have at least a bachelor’s degree. Some employers prefer candidates with degrees in business administration, finance or accounting, but other majors may be accepted as well. Additionally, many states require insurance adjusters to obtain a license before they can begin working. The requirements for licensure vary by state, but they typically include passing an exam and completing a certain amount of continuing education credits every year.

Work Environment

Claims examiners and adjusters work in different environments. Claims examiners typically work in an office environment, where they may spend their days sitting at a desk or table to review claims files. They also travel to meet with clients and insurance agents to discuss claim details.

Adjusters often work outdoors, traveling to the sites of accidents or natural disasters to assess damage and determine how much it will cost to repair property. They may also visit construction sites to ensure that contractors are following building codes and regulations.

Skills

Both claims examiners and adjusters need to have strong analytical skills to review documentation and assess the validity of claims. They also both need to be able to communicate effectively, as they often need to explain their findings to claimants.

Claims examiners tend to work for insurance companies and are responsible for reviewing insurance policies to determine if a claim is covered. They also may investigate claims to ensure that the claimant is eligible for benefits. Because of this, claims examiners need to have a strong understanding of insurance policies and how they work. They also need to be detail-oriented to ensure that they do not miss any important information when reviewing claims.

Adjusters usually work for independent firms and are hired by insurance companies to handle claims. Adjusters typically are responsible for investigating claims and negotiating settlements. They also may provide expert testimony in court cases. Because of this, adjusters need to have strong research and investigation skills. They also need to be able to think critically to assess all sides of a claim and make decisions about settlements.

Salary

Claims examiners and adjusters both work in the insurance industry. Claims examiners have an average salary of $57,409 per year, while adjusters have an average salary of $61,870 per year. Both of these salaries may vary depending on the type of insurance you work in, your level of experience and the state in which you work.