Claims Adjusters

What are claims adjusters?

Claims adjusters are professionals tasked with investigating insurance claims and evaluating how much money should be paid out to claimants. Negotiating to reach a settlement, analyzing data, and keeping records are also important aspects of the work performed by claims adjusters.

Many claims adjusters work for insurance providers, TPAs (third-party administrators), and self-insured companies, while some others work on behalf of policyholders.

To be a successful claims adjuster, it is important to manage and resolve claims carefully and accurately. But at the same time, adjusters must work quickly, both in order to ensure claimants are paid promptly (when appropriate) and in order to maximize operating efficiency (and profitability). As a result, the key qualities of top-performing claims adjusters include being smart, well-organized, confident, and conscientious.

Why is the role of the claims adjuster critical for insurance companies’ success?

Insurance providers and other insurance-related companies rely heavily on their claims adjusters. First and foremost, these adjusters have a major impact on the settlements reached between their companies and claimants. Being either too willing or too unwilling to pay out on claims can hurt a company’s bottom line significantly, and claims adjusters play a central role in reaching appropriate settlements in order to steer clear of the risks associated with either underpaying or overpaying.

At the same time, how quickly and efficiently claims adjusters work can have a major impact on a company’s bottom line. Given the scale of claims that large companies need to deal with, the operating expenses of claims departments can affect overall profitability significantly. By helping adjusters to use their work time effectively, without compromising on accuracy or reliability, these companies can help their claims departments to drive their profits.

In addition, the data provided by claims departments can help other departments to improve their own performance. Perhaps most importantly, an underwriting department should use details of claims settlements to help price future policies optimally based on the level of financial risk each policy creates. When claims departments make accurate, comprehensive data readily available to other departments as appropriate, they can help these departments to make well-informed decisions.

How does Five Sigma’s claims intelligence empower claims adjusters?

By analyzing data from past and present claims, today the kind of AI-driven technology at the heart of Five Sigma’s claims management solution (CMS) can empower even adjusters with little professional experience to perform like their most successful peers.

One of the most important ways this kind of technology helps adjusters is by providing them with just-in-time guidance to help them make well-informed decisions rapidly and minimize the likelihood that they’ll make an error. In addition, our CMS can automatically document and index claims adjusters’ incoming and outgoing communications, as well as key steps they take in managing claims. This automated system of documentation offers claims departments a streamlined way to ensure transparency.

As a whole, the kinds of claims intelligence and data-driven tools that Five Sigma offers helps claims adjusters to display the intelligence, organization, confidence, and conscientiousness they need in order to thrive. This way, entire claims departments can make sure that each adjuster has the resources they need to manage claims quickly and efficiently – without compromising on accuracy or reliability.

Back to Glossary