Insurance Claims Adjuster
Finance
Review settled claims to determine that payments and settlements are made in accordance with company practices and procedures. Confer with legal counsel on claims requiring litigation. May also settle insurance claims.
What you'd do all day
The tasks that matter most in this job, most important first.
- 1Examine claims forms and other records to determine insurance coverage.
- 2Analyze information gathered by investigation and report findings and recommendations.
- 3Pay and process claims within designated authority level.
- 4Investigate, evaluate, and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- 5Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- 6Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
- 7Investigate and assess damage to property and create or review property damage estimates.
- 8Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
- 9Interview or correspond with claimants, witnesses, police, physicians, or other relevant parties to determine claim settlement, denial, or review.
- 10Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- 11Resolve complex, severe exposure claims, using high service oriented file handling.
- 12Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- 13Confer with legal counsel on claims requiring litigation.
- 14Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- 15Refer questionable claims to investigator or claims adjuster for investigation or settlement.
- 16Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- 17Collect evidence to support contested claims in court.
- 18Supervise claims adjusters to ensure that adjusters have followed proper methods.
- 19Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- 20Conduct detailed bill reviews to implement sound litigation management and expense control.
- 21Communicate with reinsurance brokers to obtain information necessary for processing claims.
- 22Present cases and participate in their discussion at claim committee meetings.
- 23Report overpayments, underpayments, and other irregularities.
- 24Attend mediations or trials.
- 25Examine titles to property to determine validity and act as company agent in transactions with property owners.
- 26Prepare reports to be submitted to company's data processing department.
- 27Obtain credit information from banks and other credit services.
Also known as
What this job is called on JobStreet, LinkedIn and in job ads. Search these too.
- Adjuster
- Claims Agent
- Investigator
- Fire Adjuster
- Claims Analyst
- Claims Auditor
- Claims Adjuster
- Claims Adjustor
- Claims Approver
- Claims Examiner
How far is this from you?
Roughly how much preparation this job usually takes. In Malaysia your UPU route and the programme's syarat still decide entry, so treat this as a guide, not a gate.
1
Entry straight after SPM
2
SPM + sijil / short TVET course
3
Diploma / TVET (sijil–diploma)
Typical entry
Degree (ijazah sarjana muda)
5
Postgrad (sarjana / PhD) or professional route
Subjects that matter here
The SPM subjects worth your effort for this career, with the reason for each.
What you'd need to know
The subject areas this job leans on most, and the SPM subjects that build them.
- Customer and Personal Service94%
- English Language88%
English
- Administrative76%
Business
- Mathematics73%
Additional MathematicsMathematics
- Computers and Electronics69%
Computer Science / ICTElectrical & Electronic Eng. Studies
- Law and Government66%
History (Sejarah)
Tools you'd use
Software and equipment that show up in this job, worth learning early.
What the work feels like
Day-to-day working conditions, so you can tell whether the job suits how you like to work.
- Face-to-face discussionsEvery day
- Contact with other peopleConstant contact
- Dealing with customers or the publicVery high
- Leading or coordinating othersVery high
- Handling conflict situationsEvery day
- Indoors, air-conditionedEvery day
- Outdoors, in all weatherAlmost never
- Noisy environmentEvery day
AI and demand for this job
A few real, dated data points — not a single score. AI making some tasks faster usually means a job changes, not that it disappears.
Share of everyday tasks today's AI can already help with (2023)
This estimate is from 2023 — already out of date, since AI moves fast. Treat it as a rough, aging starting point, not the current picture.
Pay in Malaysia
We don't have a sourced Malaysian salary range for this job yet, and we'd rather show nothing than a number we can't stand behind.
Where to check:
- JobStreet and Hiredly job ads for this title
- DOSM Salaries & Wages Survey
- SSPA scheme tables, if you're aiming for a government post
Check what you may qualify for
Enter your SPM grades and see which routes and programmes you may qualify for. An estimate to plan with, not an offer.
How to get here
Post-SPM pathways with programmes in this career's fields. Tap one to see real programmes and entry requirements.
Related careers
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About this information
This describes what the job involves. Pay, demand and entry routes differ in Malaysia, so check the Pathways and Programmes pages for local requirements.
O*NET occupation: Claims Adjusters, Examiners, and Investigators
Job responsibilities, knowledge areas and work context from O*NET 30.3, US Department of Labor, used under CC BY 4.0. onetcenter.org