What Is the Difference Between a Claims Adjuster & a Claims Examiner?

May 31, 2020

Comparing Claims Adjusters to Claims Examiners

Adjusters and examiners both play key roles in determining how much payment someone receives after enduring personal or property damage. Adjusters examine the case to determine how much the insurance company should pay out. After the adjuster determines this and files the claim, the examiner reviews the case as a whole, making sure that everything has been filed properly by both sides. Further similarities and differences in responsibility are explored below.

Job Title Education Requirements Median Salary (2020)* Job Growth (2018-2028)**
Claims Adjuster High school diploma; postsecondary degree may be helpful $51,500 -4% (for all claims adjusters, examiners, and investigators)
Claims Examiner High school diploma; postsecondary degree may be helpful $56,289 -4% (for all claims adjusters, examiners, and investigators)

Source: *PayScale.com, **U.S. Bureau of Labor Statistics

Responsibilities of Claims Adjusters vs. Claims Examiners

Claims adjusters and claims examiners both play crucial roles in the evaluation and settling of insurance claims. While daily responsibilities may vary depending on the type of insurance industry that they work in, the primary responsibility of both positions is to ensure that claims are filed responsibly and that, if a settlement is issued, it is fair to every party involved. Adjusters' work involves going out and investigating damage; they review the situation and assess how much money should be paid out. Examiners work in offices where they look over these claims and adjusters' assessments, and determine if everything is correct and follows proper protocol.

Claims Adjuster

Claims adjusters are the professionals who investigate and assess damage after an insurance claim is filed. After inspecting a damaged home, business, or vehicle, adjusters determine how much the company they represent should pay. To determine an accurate figure, adjusters may conduct interviews with witnesses and experts, take photographs, review police reports, and make thorough notes. Due to the type of work being done, adjusters must be comfortable with travel and occasionally working unusual hours. A high school diploma is required for entry level positions, though a bachelor's degree may be beneficial.

Job responsibilities of a claims adjuster include:

  • Determine whether an insurance claim is legitimate
  • Handle settlement negotiations
  • Create detailed reports to be reviewed by management
  • Work with lawyers on contested claims

Claims Examiner

Claims examiners inspect and authorize claims after they have been submitted to ensure that the insured party and the claims adjuster have both followed proper protocol and that the final result matches the company's standards and practices. Day-to-day responsibilities usually depend on the industry that the examiner specializes in. For example, those who work in health care may directly determine whether to approve or deny a claim and how much should be paid. Examiners tend to work during normal business hours in a-n office setting and must have at minimum a high school diploma. Applicants who also have a bachelor's degree are preferred by employers.

Job responsibilities of a claims examiner include:

  • Approve or deny insurance plan applications
  • Determine if complex claims require further investigation
  • Aid adjusters during times when claims are at a high volume
  • Authorize payments to claimants

Related Careers

The insurance industry has a wide array of positions that appeal to those with varying skills and interests. If working closely with insurance documents and the special language that is used in the medical industry sounds interesting, you may want to read up on becoming an insurance coder. If selling and dealing with the public is more your style, you may want to look into becoming an insurance agent.

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