Description
Review and adjudicate property and casualty insurance claims, ensuring coverage, liability, and damages are accurately evaluated and settlements comply with policy, company procedures, and regulations. Handle complex files, set and adjust reserves, authorize payments within authority, and coordinate with legal counsel, SIU, and vendors to achieve fair, timely resolution.
- • Examine claim forms and policy to determine coverage for property and casualty losses.
- • Analyze investigation findings and document recommendations.
- • Review police reports, repair estimates, appraisals, medical bills, and photos to assess liability and damages.
- • Investigate and evaluate property damage; review and approve estimates and scopes.
- • Interview or correspond with claimants, insureds, agents, and witnesses to clarify facts and resolve discrepancies.
- • Determine and recommend claim disposition: settlement, denial, or further review per policy and state regulations.
- • Set, monitor, and adjust reserves in line with corporate guidelines.
- • Authorize and process payments within authority; ensure accurate indemnity and expense payments.
- • Refer suspected fraud or complex issues to SIU or appropriate specialists.
- • Conduct quality reviews of adjuster-handled files; provide direction to field or independent adjusters.
- • Verify and analyze data to ensure claim validity and compliance with company practices and procedures.
- • Maintain complete, timely, and accurate claim file documentation in the claims system.
- • Present complex cases and recommendations at claim committee or roundtable meetings.
- • Coordinate litigation strategy with defense counsel; attend mediations, depositions, or trials as needed.
- • Implement litigation and expense management, including detailed bill review and budgets.
- • Identify and pursue subrogation, salvage, and recovery opportunities.
- • Communicate with reinsurance brokers or carriers and prepare notifications and reports as required.
- • Prepare regulatory, financial, and management reports; ensure accurate coding and system updates.
- • Provide exceptional customer service and timely status updates to stakeholders.
- • Ensure compliance with state insurance regulations, fair claims practices, and internal guidelines.
- • Collaborate with vendors (appraisers, engineers, contractors) and schedule inspections when appropriate.
- • Enter new claims and reserves; update file notes with concise, relevant documentation.
- • Report overpayments, underpayments, and other irregularities and take corrective action.
- • Negotiate settlements or recommend litigation when settlement is not achievable.
- • Evaluate coverage issues and draft coverage position letters.
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This site includes information from O*NET by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license. Career Clutch has modified some of this information for student readability. USDOL/ETA has not approved, endorsed, or tested these modifications. O*NET® is a trademark of USDOL/ETA.
Last reviewed: Jan 2026
