Claims Representative vs. Adjuster: What Are the Differences?

A career in insurance can be both exciting and rewarding. If you’re interested in this industry, you may be wondering what the difference is between a claims representative and an adjuster. Both positions work with insurance claims, but there are key distinctions between the two. In this article, we compare and contrast claims representatives and adjusters, and we provide information on what you can expect from each role.

What is a Claims Representative?

A Claims Representative is a customer service professional who works for an insurance company. They manage customer inquiries and phone calls, often providing policy information and updates. They work to resolve customer claims in a timely and efficient manner. Claims Representatives also process customer claims by gathering the necessary documentation and information. They may also work with medical professionals and providers to get additional information about a claim. In some cases, Claims Representatives may also visit customers at their homes or businesses to conduct an in-person investigation.

What is an Adjuster?

Insurance Adjusters are responsible for investigating insurance claims and determining the amount of money that should be paid to the policyholder. They review police reports, medical records, insurance policies and speak with witnesses to get a clear understanding of the incident. Adjusters also interview the claimants to get their account of what happened. After investigating the claim, the Adjuster will then determine if the claim is valid and how much money should be paid out. If the claimant is not satisfied with the Adjuster’s decision, they may file an appeal.

Claims Representative vs. Adjuster

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

Job Duties

Claims representatives perform a variety of tasks, including researching the facts of a claim, contacting involved parties and creating claims files. They also communicate with insurance customers about policy details, coverage options and claim status.

Adjusters evaluate damage to property and investigate incidents to determine how they affect insurance policies. They use this information to decide whether to approve or deny claims. Additionally, adjusters make recommendations to improve insurance policies and processes.

Job Requirements

Most insurance companies require claims representatives and adjusters to have at least a high school diploma, although some may prefer candidates with an associate or bachelor’s degree. Many organizations also offer on-the-job training for new employees. Some states also require insurance adjusters to obtain a license before they can begin working. To become licensed, applicants must pass an exam that covers topics like insurance law and policyholder rights.

Work Environment

Claims representatives and adjusters work in different environments. Claims representatives typically work in an office setting, where they can access information about their clients’ claims easily. They may also travel to meet with clients or visit accident sites to gather evidence for a claim.

Adjusters often work outdoors, inspecting damage caused by natural disasters or accidents. They may spend long hours on the job, as they must assess damages quickly and efficiently.

Skills

Both claims representatives and adjusters need to have customer service skills when working with policyholders. This includes being able to listen to customers, understand their needs and provide them with information about the claims process.

Both of these positions also require research skills. Claims representatives may need to research a customer’s policy to determine if a claim is covered, while adjusters may need to research the cause of damage to develop an estimate for repairs.

Organizational skills are important for both of these positions, as they often need to keep track of multiple claims at one time. They may also need to coordinate with other departments within an insurance company, such as underwriting or fraud investigation.

Claims representatives typically need to have a strong understanding of the claims process and how different types of insurance coverage work. Adjusters usually need more in-depth knowledge about the causes of damage and the repair process. They may also benefit from having engineering skills or experience in the construction industry.

Salary

Claims representatives and adjusters both work in the insurance industry. Claims representatives earn an average salary of $50,035 per year, while adjusters earn 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.