Industry

Claims Adjuster

A claims adjuster is an insurance professional who evaluates insurance claims to determine the extent of the insurer's liability. They investigate losses, assess damages, verify coverage, negotiate settlements, and decide how much the insurance company should pay on a claim.

In this article

Types of claims adjusters What adjusters do day-to-day Adjusters and fraud detection Key points How Hesper AI helps FAQ

Types of claims adjusters

There are three main types: staff adjusters (employed directly by the insurance company), independent adjusters (contractors hired by insurers, often for overflow or catastrophe response), and public adjusters (hired by policyholders to represent their interests against the insurer). Staff adjusters handle the majority of day-to-day claims. Independent adjusters are critical during catastrophic events when claim volume surges.

What adjusters do day-to-day

An adjuster's workflow includes: reviewing FNOL reports, contacting claimants, inspecting damage (in person or via photos/video), reviewing policy coverage, obtaining repair estimates, negotiating with claimants and contractors, identifying subrogation opportunities, and deciding whether a claim should be referred to the SIU for investigation. A typical staff adjuster handles 100-150 active claims simultaneously.

Adjusters and fraud detection

Adjusters are the first line of fraud detection. Through their direct interaction with claimants and inspection of losses, they observe behavioral red flags, damage inconsistencies, and documentation problems that automated systems may miss. However, adjusters are not trained investigators - when fraud is suspected, the claim should be referred to the SIU. The challenge is that adjusters are evaluated on closure speed, creating tension between thorough investigation and efficient processing.

Key points

Evaluates claims to determine insurer liability and payout amount
Three types: staff (company), independent (contractor), public (hired by policyholder)
Typical staff adjuster handles 100-150 active claims
First line of fraud detection through direct claimant interaction
Evaluated on closure speed, creating tension with thorough investigation

How Hesper AI helps

Hesper AI supports adjusters by handling the investigation workload that adjusters don't have time for. When an adjuster suspects fraud, Hesper takes over the evidence gathering, document verification, and report generation - giving the adjuster a complete investigation package without pulling them off their other 150 claims.

Related glossary terms

First Notice of Loss (FNOL)Special Investigations Unit (SIU)Subrogation

Frequently asked questions

Requirements vary by state. Most states require adjusters to pass a licensing exam and complete continuing education. Staff adjusters typically have a bachelor's degree and receive company training. Many pursue professional designations like the Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU). Independent adjusters need state licenses in each state where they operate.

A claims adjuster evaluates and settles claims - assessing damage, verifying coverage, and determining payment. A claims investigator (SIU) investigates suspected fraud - gathering evidence, conducting interviews, and building cases for denial or legal action. Adjusters handle all claims; investigators handle only suspected fraud referrals. In practice, adjusters identify potential fraud and refer it to investigators.

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