Occupation Spotlight: Claims Adjusters, Examiners, and Investigators

Occupation Spotlight: Claims Adjusters, Examiners, and Investigators

When accidents happen, insurance companies rely on a dedicated team of professionals to investigate and assess claims, ensuring fair compensation for policyholders. Claims adjusters, examiners, and investigators play a vital role in this process, meticulously evaluating the details of the incident and determining the appropriate coverage and settlement. In this article, we delve into the world of claims professionals, exploring their job responsibilities, required skills, and the path to entering this rewarding field.

Understanding the Role

Claims adjusters, examiners, and investigators are responsible for investigating insurance claims, assessing the extent of damages, and determining the compensatory amount based on the policyholder’s coverage. Let’s take a closer look at the different roles within this occupation:

1. Claims Adjusters: Their primary task involves evaluating property and casualty insurance claims. These professionals meet guidelines set by the insurance company to determine the legitimacy and value of the claim. Once the investigation is complete, claims adjusters negotiate settlements with policyholders.

2. Examiners: These professionals focus primarily on reviewing and evaluating claims for accuracy and completeness. They scrutinize policy details, verify facts, collect additional information as needed, and determine if the claim should be approved or denied based on policy conditions.

3. Investigators: Investigators specialize in cases where insurance fraud is suspected. Using various investigative techniques, these professionals gather evidence to determine the legitimacy of the claim. They may interview witnesses, inspect accident scenes, consult with experts, or examine medical records to uncover any fraudulent activity.

Education and Training Requirements

To pursue a career as a claims adjuster, examiner, or investigator, certain educational qualifications and training are typically required. While some positions may only require a high school diploma or equivalent, most employers prefer candidates who have completed relevant postsecondary education or possess industry certifications in insurance claims handling.

Examples of degrees and certifications that can enhance your chances of getting hired include:

  • Bachelor’s degree in forensic science, criminal justice, insurance, or a related field
  • Coursework or certification in insurance claims handling, fraud examination, or risk management
  • Professional certifications such as the Associate in Claims (AIC), the Senior Claims Law Associate (SCLA), or the Fraud Claims Law Associate (FCLA)

Furthermore, gaining experience in fields such as law enforcement, customer service, or insurance can provide a valuable foundation for a career in claims handling.

Progression and Advancement

Progression within the claims adjusting field typically involves a combination of professional experience, additional education or certifications, and demonstrated expertise. As entry-level claims professionals gain practical knowledge and expertise, they can advance to more complex claims and higher levels of responsibility.

Companies may also offer their employees opportunities for career advancement and professional development. This can include training programs, mentorship initiatives, or even sponsorship for advanced certifications such as the Chartered Property Casualty Underwriters (CPCU) designation, which is highly regarded in the industry.

Entering the Field

If you’re new to the claims adjusting field, there are several pathways you can take to break into this profession:

  1. Gain relevant education: Pursue a degree or certification that provides a solid foundation in claims handling, risk management, or insurance.
  2. Acquire industry knowledge: Familiarize yourself with industry terminology, insurance policies, and claims handling processes by conducting research or taking online courses.
  3. Apply for entry-level positions: Look for job openings as a claims assistant or trainee at insurance companies, independent adjusting firms, or investigative agencies.
  4. Network and intern: Attend industry events, join professional organizations, and consider internships to gain practical experience and to connect with experienced claims professionals.
  5. Highlight relevant skills: Emphasize your analytical acumen, attention to detail, strong communication skills, and ability to work independently and efficiently in your job applications and interviews.

By strategically pursuing these steps, you can position yourself to kick-start a successful career in claims adjusting, examining, or investigating.


Claims adjusters, examiners, and investigators play a crucial role in evaluating and assessing insurance claims. They investigate incidents, determine coverage, and negotiate settlements, ensuring fair compensation for policyholders. To enter this field, a combination of education, industry knowledge, and relevant experience is required. Advancement opportunities exist through gaining expertise, pursuing additional education or certifications, and taking advantage of company-sponsored development programs. By following the right steps, aspiring claims professionals can successfully establish themselves in this rewarding occupation.