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Claims Adjuster - Career Profile |
Career OverviewA claims adjuster is responsible for investigating or examining insurance claims, working with the insurer and the client to resolve problems, and recommending payments to the claimant or the healthcare provider.
The claims adjuster may be required to talk to hospital and medical staff as well as treatment staff to determine the extent of the claim and appraise a fair value for the claim. They may be required to complete additional research or investigation and may also have to submit additional paperwork to the insurance company regarding proof the medical insurance claim.
A claims adjuster must be able to think logically, ask questions and find relevant information for claims efficiently and strategically. He or she should also be able to communicate with both the patient and the medical staff and should have an ability to work with people that may have impairments due to ongoing health issues.
Excellent written processing skills, knowledge of currently policies, procedures, laws and guidelines for medical insurance is essential. The claims adjuster should have negotiation skills and should be effective at working with people that are upset and angry.
A claims adjuster may be required to work with hospital and insurance company, as well as patient’s attorneys to attempt to resolve any issues with claims before going to court. A claims adjuster will also work closely with an insurance investigator if they believe that the claim is fraudulent.
A claims adjuster usually works a fairly standard hourly job although there may be some travel involved in certain hospital or healthcare facilities. Often the claims adjuster may work at more than one hospital or care facility, especially in smaller areas or hospitals.
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Career RequirementsMost claims adjusters working in the healthcare field have a background in some aspect of medicine. This may be a Bachelor level or pre-med type education in combination with the state requirements for licensed claims adjusters. Some claims adjusters working for a large insurance company may not be required to be individually licensed; rather they are protected under the company’s license.
Each state has different requirements for a claims adjuster. Most states require that the claims adjusters attend a set number of professional development events or hours per year to maintain their license. Most agencies use a mentor system with new claims adjusters working with senior staff and gradually taking on new cases of their own as they become more familiar with the claims process.
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Job OutlookIt is anticipated that the demand for new claims adjusters will remain steady over the next several years. Overall the increase in patient hospitalization, increase in claims for medical services and increase in number of patients in long-term care has kept the employment levels high for claims adjusters.
Some increase in technology and self-service type claims has decreased the demand for claims adjusters to handle every case, therefore balancing the increased hospital populations. Since claims adjuster is usually an entry level position in the insurance field there is a constant need for people at this level as more senior individuals move into other areas.
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Career TrackA claims adjuster with several years of experience has many options for moving in the insurance market. They may choose to become mentors, supervisors, or even department managers once they have enough experience. A claims adjuster may also decide to move into working on insurance investigations or may also move towards insurance appraisers roles.
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CompensationClaims adjusters generally earned between $34,000 and $57,000 per year, plus bonuses and additional features of the job. This may include computers, phones and even company cars or expense accounts for travel. Senior level claims adjusters in the top 10% of the total marketplace often earn in excess of $72,000 per year.
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