Claims Adjuster Job Description

Claims Adjuster I denies, settles, or authorizes payments to routine property/casualty claims based on coverage, appraisal, and verifiable damage. Corresponds with policyholders, claimants, witnesses, attorneys, etc. to gather important information to support contested insurance claims. Being a Claims Adjuster I makes recommendations for settlement of routine property/casualty claims based on coverage, appraisal, and verifiable damage. Prepares reports of investigation findings. Additionally, Claims Adjuster I may conduct field evaluations to inspect and document damage or loss. Typically requires an associate degree. Typically reports to a supervisor or manager. The Claims Adjuster I works on projects/matters of limited complexity in a support role. Work is closely managed. To be a Claims Adjuster I typically requires 0-2 years of related experience.

Claims Adjuster Job Description Template

Our company is looking for a Claims Adjuster to join our team.

Responsibilities:

  • Communicate and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding;
  • Complete on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements.

Requirements:

  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications;
  • High School Diploma / GED (or higher);
  • 1+ years of Customer Service Representative (CSR) experience or 1+ years of experience in an office setting, call center setting or phone support role;
  • Familiar with small group or self – funded product designs;
  • Previous experience with medical claims processing preferred;
  • Understanding of UHOPS processing system.