What does this person do?
When a customer has had an accident, been injured, or been through a loss, adjusters help determine a fair settlement between all involved. Loss adjusters investigate insurance claims arising out of losses such as fires, car accidents and burglaries. They determine the amount of damage or loss covered by the insurance policy. They then make recommendations regarding payment of benefits, based on the coverage noted on the insurance policy and negotiate payment and settlement. Adjusters spend time in the field, as well as behind a desk.
Loss adjusters also:
- Receive claim information from a Claims Investigator, Claims Assessor or Negotiator of an Insurance Company and investigating the circumstances around the claim to ensure that the peril which caused the loss or damage is in fact an insured peril.
- Ensure that those who have suffered a loss receive all of the benefits and assistance to which they are entitled.
- Assessing a claim to make recommendations to an insurer on whether the claim should be settled or rejected.
- In disputed claims, may also be required to investigate the cause of the loss – how a fire started, why a plane went down, etc.
- Investigate, negotiate and settle a variety of claims in an efficient manner and in compliance with a variety or requirements.
- Conduct witness interviews, take statements and consult with police reports.
- Report in a variety of ways – in writing, through e-mail or on-line, and must present or report on these findings, propose solutions and negotiate settlements and agreements with third parties, clients or other concerned parties.
- Inspect and/or evaluate damages when required, estimate costs or commercial value, examine reports or other documents, evaluate losses, establish claims guidelines and quantifying settlement amounts.
- Participate in private and/or mandatory mediation, settlement meetings, settlement conferences, pre-trials, court proceedings and other dispute resolution methods as required.
A successful claims adjuster must have excellent communication and negotiation skills and should be able to arbitrate with grace and empathy. They must also have knowledge of the human body, technical legal information and require superior communication and problem-solving skills. Also the following is crucial:
- You are naturally inquisitive with a keen interest in criminal or civil investigation and strong computer proficiency
- You are a strong communicator with exceptional decision-making, problem-solving and investigation skills
- You are analytical, thorough and customer-service oriented.
The training you will require to work in this occupation will depend on the nature of the insurance environment in which you work (i.e. short-term insurance, long-term insurance, medical or other specialist insurance). Different training and regulations also apply to those working directly with clients versus those working in the claims-handling divisions of the insurance industry.
A number of learnerships at NQF Level 4 are applicable to the occupation of Insurance Loss Adjustor. The type of learnership you do will depend on the nature of your work environment. While you require a minimum of a Grade 11 or NQF Level 3 qualification to access these learnerships, most people only access them after having completed a National Senior Certificate or Grade 12 with Mathematics and Accounting as subjects:
- Learnership in Short Term Insurance Level 4
- Learnership in Long Term Insurance Level 4
- Learnership in Medical Claims Assessing Level 4
- Learnership in Short -Term Risk Management Level 4
- Learnership in Long Term Risk Assessment Level 4, which can be followed by the Learnership in Long Term Risk Assessment Diploma Level 5
It should be noted that in the Long Term, Health Insurance and Specialist Insurance markets (e.g. motor or aeroplane insurance) many Insurance Loss Adjustors may be required to have a medical or other specialist qualification that is relevant to the field.
Please note that the learning paths for the occupations of Insurance Investigator, Insurance Risk Surveyor, Insurance Agent and Insurance Broker may also be relevant to the occupation of Insurance Loss Adjustor.
Loss adjusters are often hired by insurance companies, government services or independent adjusting firms.
The Insurance Institute of South Africa (IISA) offers Programs in Insurance, or provides recognition of other insurance related qualifications or courses. These are needed in order to register as an IISA Member.
Designations: Designations are awarded by the Insurance Institute of South Africa (IISA). A designation is a title that professional persons may use (write behind their name) to indicate that they are fully qualified in a certain professional field and are registered with a professional body to practice in that field. It also indicates that the person subscribes to the code of conduct of that professional body. The Insurance Institute of South Africa (IISA) offers the following designations:
- Fellow of the Insurance Institute of South Africa (FIISA)
- Licentiate of the Insurance Institute of South Africa (LIISA)
- Associate of the Insurance Institute of South Africa (AIISA)