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Claims Adjusters, Examiners, and Investigators

SOC 13-1031.00Job Zone 4 · Considerable Preparationv.26.05

Context coveredThis framework covers the full career arc of Claims Adjusters, Examiners, and Investigators working across property, casualty, liability, and medical lines in insurance carriers and third-party administration environments, from supervised entry-level case handling through executive-level strategic leadership.

Sources:O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.SkillsCrosswalkSkillsCrosswalk — O*NET enrichment + adjacency index. Opens in new tab.
Emerging
Entry / Apprentice
  1. Claims forms and supporting records — review and organize under direct supervision to identify applicable insurance coverage on straightforward property or liability cases.
  2. Policy language and coverage terms — interpret with guidance to determine whether a submitted claim falls within the scope of a standard insurance contract.
  3. Data entry and document management software — use to input claim details and maintain accurate electronic files within the company's ERP or document management system.
  4. Police reports and medical records — locate and compile under supervisor direction to support initial determination of liability extent.
  5. Claimant interviews — conduct introductory conversations by phone or written correspondence using prepared scripts to gather basic facts about a reported loss.
  6. Claims processing procedures — follow established company protocols to route and pay straightforward claims within assigned authority limits.
  7. Property damage estimates — review pre-prepared estimates using office suite software and flag discrepancies for senior adjuster review.
  8. Office suite and internet browser tools — use to research coverage precedents, retrieve policy documents, and draft routine claim correspondence.
  9. Basic mathematical calculations — apply to verify reserve amounts and initial settlement figures against documented losses on low-complexity claims.
  10. Reporting templates — populate with investigation findings and submit to supervisors for quality review at the conclusion of each assigned case.
Developing
Mid-level / Established
  1. Insurance coverage determinations — analyze claims forms, policy endorsements, and exclusions independently to resolve coverage questions on moderately complex cases.
  2. Investigation data — synthesize information gathered from multiple sources, including medical records and physical inspections, to produce written findings and settlement recommendations.
  3. Claims settlements — negotiate and process payments within designated authority levels, applying company practices and regulatory requirements with reduced oversight.
  4. Liability assessments — evaluate police reports, medical treatment records, and billing documentation to calculate the extent of insurer obligation on personal injury claims.
  5. Property damage inspections — conduct on-site assessments of damaged structures or vehicles, creating or reviewing repair estimates using financial analysis or CAD-based estimating tools.
  6. Questionable claim indicators — identify through active listening and document analysis during claimant and agent interviews, escalating suspected fraud patterns appropriately.
  7. Claim reserve accuracy — monitor and adjust reserve levels throughout the life of a case to reflect emerging information and compliance with administrative guidelines.
  8. Negotiation conversations — lead settlement discussions with claimants, attorneys, and repair vendors, applying social perceptiveness to reach fair and prompt resolutions.
  9. Time management practices — prioritize a moderate caseload to meet statutory response deadlines and internal cycle-time targets across varied lines of business.
  10. Expert system and billing software — use to validate medical bills and fee schedules against industry databases, ensuring payments align with contractual and legal standards.
Proficient
Senior / Expert IC
  1. Complex multi-party liability claims — investigate, evaluate, and settle autonomously, applying advanced technical knowledge and human relations skills to reduce loss ratios across a high-volume caseload.
  2. Coverage disputes and denials — resolve non-routine coverage questions by synthesizing policy language, case law, and regulatory guidance, producing well-documented written rationales.
  3. Large-loss property damage — direct field investigations and oversee contractor estimates using CAD software and financial analysis tools, validating total replacement or repair costs on high-exposure cases.
  4. Fraud detection patterns — apply inductive and deductive reasoning to investigate inconsistencies across claim documents, recorded statements, and third-party data, recommending referral to special investigations units.
  5. Litigation management — collaborate with defense counsel, monitor case strategy, and authorize settlements up to authority limits on litigated claims involving significant financial exposure.
  6. Regulatory and legal compliance — ensure all claim-handling activities conform to state insurance codes, privacy regulations, and company administrative standards across all assigned territories.
  7. Stakeholder communications — negotiate effectively with claimants, public adjusters, medical providers, and legal representatives, leveraging oral expression and active listening to achieve equitable outcomes.
  8. Loss trend analysis — monitor claim patterns within a book of business using financial analysis software, identifying systemic issues and providing data-driven recommendations to underwriting and management.
  9. Training and guidance — mentor junior adjusters on investigation techniques, coverage analysis, and negotiation strategy during routine case reviews and joint field activities.
  10. Claims technology optimization — evaluate and fully utilize ERP, document management, and expert system platforms to streamline workflow and maintain audit-ready case documentation.
Advanced
Lead / Principal / Executive
  1. Claims department strategy — set organizational direction for investigation standards, authority matrices, and loss-control objectives aligned with enterprise financial targets and risk appetite.
  2. Authority guidelines and best practices — develop and publish company-wide claims-handling protocols, coverage interpretation manuals, and settlement authority frameworks for all lines of business.
  3. Catastrophe response programs — design and lead large-scale multi-adjuster deployments in response to natural disaster or mass-casualty events, coordinating resources across regions and vendors.
  4. Loss ratio performance — lead executive-level analysis of claim cost drivers, presenting recommendations to senior leadership on reserve adequacy, pricing feedback, and litigation strategy adjustments.
  5. Regulatory relationships — represent the organization in interactions with state insurance departments, legislative bodies, and industry associations to shape compliance obligations and claims standards.
  6. Workforce development — create and sponsor competency-based training curricula, licensing programs, and career development pathways for the full claims workforce pipeline.
  7. Technology investment decisions — evaluate and champion adoption of AI-assisted triage tools, advanced expert systems, and predictive analytics platforms to modernize claims operations at organizational scale.
  8. Cross-functional leadership — partner with actuarial, underwriting, legal, and finance executives to align claims operations with product design, pricing models, and corporate governance requirements.
  9. Vendor and partner ecosystem — negotiate and oversee strategic contracts with independent adjusting firms, medical management vendors, legal panels, and repair networks to optimize quality and cost.
  10. Organizational culture and ethics — model and institutionalize standards of integrity, attention to detail, and fair-dealing that define the company's claims brand and support long-term customer retention.

AI-at-Work Competency Framework

Sources:Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab.Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab.WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab.
Subscriber feature

Authoritative source data identified for 998 occupations

How a worker at each mastery level uses, directs, and evaluates AI tools in this occupation. Each statement cites its evidence inline; click a citation chip to verify the source.

Emerging
  1. AI-assisted document review — uses an AI tool to surface relevant policy terms and coverage details from claims forms, reducing initial review time while manually verifying each extracted data point Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  2. Coverage lookup delegation — submits claim form text to an AI assistant to identify applicable policy provisions, then cross-checks the output against the original policy documents before proceeding Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
Developing
  1. Claim validity screening — directs an AI tool to flag inconsistencies and missing data across claim records, then applies critical thinking to confirm or override each flag before advancing the claim Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  2. Investigation summary drafting — hands off gathered incident data to an AI assistant to produce a structured findings draft, then edits for accuracy and regulatory compliance before submission Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
  3. Settlement calculation support — uses AI-generated cost estimates and precedent comparisons as a starting baseline, then adjusts figures using own judgment within designated authority levels Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
Proficient
  1. End-to-end claim triage — orchestrates AI-assisted intake to classify incoming claims by complexity and coverage type, personally handling edge cases that require human relations skills and nuanced judgment Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  2. Data verification workflow — integrates AI tools into the verification pipeline to cross-reference claimant data against policy records and loss histories, retaining sign-off authority on every settlement decision Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  3. Analytical report generation — directs an AI assistant to compile multi-source investigation data into draft reports, then rewrites conclusions to reflect accurate liability assessments and company practices Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
  4. Pattern-based fraud detection — leverages AI anomaly-detection outputs to prioritize claims for deeper investigation, applying domain expertise to distinguish systemic fraud indicators from legitimate outliers WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
Advanced
  1. AI workflow architecture — designs the claims unit's AI-assisted review process, defining which task categories are delegated to automated tools versus reserved for examiner judgment, and audits model outputs for systematic bias Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  2. Cross-portfolio loss analysis — directs AI tools to aggregate settlement data across large claim portfolios, then synthesizes findings into strategic recommendations that reduce the overall loss ratio Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  3. Model calibration oversight — evaluates AI autonomy boundaries across the claims pipeline, adjusting delegation thresholds when tool performance drifts from company accuracy standards Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  4. Examiner capability development — coaches junior adjusters on productive AI collaboration patterns, establishing team norms for when to override AI outputs and how to document human-in-the-loop decisions Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
Evidence pack
AEI usage
Task observations: 564
Augment share: 56.4%
Time saved: 84.2%
AI autonomy: 2.90
SAFI positioning
Top skill: Reading Comprehension
Score: 45.5 / 100
Quadrant: Q2_ai_augmented
precision: exact
WEF cluster
Data Science and Analysis
data_science_and_analysis
Sources:Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab.Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab.WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab.

Pathsmith Durable Skills Framework

Sources:Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Subscriber feature

Ten durable-skill domains mapped to four proficiency/role levels for each occupation. Each statement is aligned to the Pathsmith taxonomy, derived from trusted grounding data and mapped to occupation-specific O*NET tasks and skills.

1Communication10 statements
Emerging
  1. Claims intake documentation — records claimant statements and basic incident details through structured intake forms with supervisor guidance Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Claimant correspondence — drafts routine acknowledgment letters and status updates using approved templates under review O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Field interview communication — elicits incident details from claimants, witnesses, and agents through structured questioning while maintaining professional rapport Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Claims findings summary — writes clear investigation summaries describing damage extent, liability factors, and recommended settlements for internal review O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Error resolution correspondence — contacts agents and claimants in writing or by phone to correct omissions or discrepancies on claims forms O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Adverse decision explanation — communicates claim denials or partial settlements to claimants with clear reference to policy language, evidence, and legal basis Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Multi-party claims communication — conveys findings and settlement positions to attorneys, medical providers, contractors, and insureds in a single claims file simultaneously O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Investigation report authorship — produces complete, legally defensible written reports integrating police records, medical documentation, and property damage assessments O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Complex litigation communication — presents technical claims findings and expert testimony summaries to legal counsel, mediators, and senior management with precision and clarity Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Cross-functional communication leadership — establishes communication standards and templates for the claims unit to ensure consistent, compliant claimant interaction across all adjusters Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
2Leadership8 statements
Emerging
  1. File ownership initiative — takes personal responsibility for assigned claims files, tracking deadlines and escalating issues to supervisors proactively Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Peer knowledge sharing — shares newly learned policy interpretations or procedural updates with teammates during team meetings Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Claims authority exercise — makes independent settlement decisions within designated authority levels without requiring supervisory sign-off on routine files O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Vendor coordination leadership — directs independent appraisers, contractors, and medical reviewers to gather necessary evidence on schedule O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Caseload prioritization leadership — organizes and directs the sequencing of complex, high-exposure files to meet settlement timelines and reduce loss ratios Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Junior adjuster mentorship — guides developing adjusters through coverage interpretation, liability analysis, and settlement negotiation on shared or observed files Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Claims unit strategy leadership — leads workflow redesign initiatives, authority threshold reviews, and training programs that measurably improve team settlement outcomes Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Fraud investigation leadership — takes charge of multi-file suspected fraud rings, coordinating with SIU, law enforcement, and legal counsel to protect company interests O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
3Metacognition8 statements
Emerging
  1. Coverage gap awareness — recognizes personal knowledge limits in unfamiliar policy forms and seeks supervisor or reference material guidance before making coverage determinations Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Decision reflection — reviews closed files to identify patterns in errors or missed investigation steps for self-correction Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Investigation strategy planning — consciously selects which records, interviews, and inspections to prioritize based on the specific liability theory of each claim Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Bias recognition in liability assessment — monitors own reasoning for anchoring to initial claimant statements before reviewing contradicting physical or medical evidence Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. Settlement reasoning audit — evaluates own valuation methodology against comparable closed files and reserve benchmarks before finalizing high-exposure settlements Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Regulatory knowledge monitoring — tracks gaps in personal knowledge of state-specific claims handling regulations and schedules targeted learning to close those gaps Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Systemic reasoning evaluation — analyzes own and team decision-making patterns across large file populations to identify cognitive shortcuts causing reserve inadequacy or overpayment Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Expert estimation calibration — compares personal damage estimates against final appraisal outcomes over time to refine and recalibrate internal valuation benchmarks Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
4Critical Thinking10 statements
Emerging
  1. Coverage applicability identification — reads policy declarations and insuring agreements to determine whether a reported loss falls within basic coverage parameters Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Document inconsistency detection — flags discrepancies between claimant statements and submitted forms for supervisor review O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Liability factor analysis — evaluates police reports, witness statements, and physical evidence to assign comparative or contributory negligence across parties Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Medical record scrutiny — reviews treatment records and billing to determine whether claimed injuries are consistent with the mechanism of the reported accident O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Exclusion and condition analysis — identifies applicable policy exclusions, conditions, and endorsements that limit or modify coverage on complex claims O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Multi-source evidence synthesis — integrates property inspection findings, medical opinions, legal filings, and financial records into a coherent liability and damages conclusion Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Fraudulent claim pattern recognition — applies logical analysis to identify staged accidents, inflated damages, or misrepresented facts based on physical and documentary inconsistencies Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Settlement value reasoning — constructs reasoned settlement range analysis weighing exposure, liability probability, litigation cost, and precedent from comparable verdicts Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Coverage dispute resolution — analyzes complex coverage questions involving multiple policies, excess layers, and reservation-of-rights scenarios with independent legal reasoning Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Claims trend critical analysis — evaluates portfolio-level claims data to identify systemic underwriting, fraud, or investigation quality problems and recommends corrective strategies Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
5Collaboration8 statements
Emerging
  1. Internal team coordination — shares relevant file information with underwriting, legal, and customer service colleagues when requested during routine claims handling Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Vendor onboarding collaboration — works with assigned appraisers or contractors to clarify scope of damage inspection assignments O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Cross-functional file collaboration — coordinates with medical reviewers, attorneys, and SIU simultaneously on litigated or suspicious claims without losing file momentum Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Agent partnership — collaborates with insurance agents to gather complete policy and incident information and resolve reporting errors efficiently O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Negotiation collaboration — partners with claimant representatives, defense counsel, and mediators in structured settlement negotiations to reach mutually acceptable resolutions Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Catastrophe response teamwork — integrates into temporary surge teams during large loss events, coordinating file assignments and shared resources with regional and national adjusters Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Inter-departmental process improvement — leads collaborative initiatives between claims, underwriting, and actuarial teams to align claims handling practices with loss ratio and reserving goals Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Industry collaboration — represents the organization in industry working groups or regulatory stakeholder discussions on claims handling standards and best practices Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
6Character8 statements
Emerging
  1. Claims file integrity — records all investigation findings accurately in the claims system without omission or alteration, regardless of outcome impact on reserves Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Regulatory compliance adherence — follows state-mandated claims handling timeframes and required notices even when workload creates pressure to delay Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Impartial claimant treatment — applies the same evidentiary standards and settlement criteria to all claimants regardless of demographics, relationship, or claim complexity Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Authority boundary accountability — submits files for supervisory approval when settlements approach or exceed personal authority limits rather than forcing premature closure Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Ethical settlement practice — pays valid claims promptly and in full within authorized limits without strategically delaying payment to improve financial ratios Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Conflict of interest disclosure — proactively identifies and discloses personal or professional relationships with claimants, vendors, or legal representatives that could compromise objectivity Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Ethical culture stewardship — models and enforces fair claims handling standards across the team, challenging practices that exploit claimant vulnerability or misrepresent policy obligations Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Whistleblower courage — reports observed fraud, regulatory violations, or unethical settlement practices through appropriate channels despite organizational or interpersonal pressure Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
7Creativity8 statements
Emerging
  1. Alternative evidence sourcing — identifies non-standard documentation sources such as social media records or satellite imagery to supplement incomplete claims files Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Claimant engagement problem-solving — generates alternative contact strategies when standard outreach to claimants or witnesses is unsuccessful Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Damage estimation innovation — applies creative cross-referencing of repair cost databases, local contractor rates, and comparable loss data to produce defensible non-standard damage estimates Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Settlement structure creativity — proposes structured settlements, repair-in-kind alternatives, or partial payments to resolve contested claims when standard cash offers are rejected Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Investigation design — constructs novel investigation plans for unusual or high-complexity claims combining field inspection, surveillance, expert engagement, and records subpoena strategies Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Coverage argument construction — develops creative but legally grounded coverage positions on ambiguous policy language to protect company interests or honor legitimate claims Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Claims process innovation — designs new workflows, triage models, or technology integrations that materially improve settlement speed, accuracy, or fraud detection across the claims unit Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Training content creation — develops scenario-based training cases drawn from complex closed files to build critical judgment skills in developing adjusters Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
8Growth Mindset8 statements
Emerging
  1. Feedback integration — incorporates supervisor file review feedback into subsequent investigation and documentation practices within the same assignment period Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Unfamiliar coverage learning — approaches assignment to new lines of business or coverage types as a development opportunity rather than a disruption Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Continuing education pursuit — proactively completes adjuster continuing education, designation coursework, or state licensing updates beyond minimum requirements Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Difficult file persistence — sustains investigation effort on stalled, uncooperative, or legally complex claims rather than prematurely closing or settling to reduce workload Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Adverse outcome learning — conducts structured post-mortem analysis of files resolved by verdict, arbitration, or regulatory complaint to extract actionable improvements Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Regulatory change adaptation — rapidly integrates new state insurance regulations, court decisions, or company policy changes into daily claims handling practice Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Industry knowledge leadership — pursues advanced designations, legal education, or actuarial training to expand the technical ceiling of claims expertise within the organization Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Team learning culture — establishes structured file review, peer calibration sessions, and shared learning libraries that embed continuous improvement into team norms Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
9Mindfulness8 statements
Emerging
  1. Emotional neutrality in claimant contact — maintains calm, non-reactive tone when claimants express frustration, grief, or anger during initial claims interviews Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Workload awareness — monitors personal caseload volume and flags to supervisors when capacity constraints risk timely claims handling Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Attention management on complex files — sustains focused document review across lengthy medical records, legal briefs, or financial statements without premature conclusion Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Deliberate decision pacing — pauses before finalizing high-stakes settlement decisions to verify that all evidence has been reviewed and authority limits confirmed Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Empathic claimant presence — remains attentive and responsive to claimant emotional state during in-person or phone interviews involving injury, death, or property loss without losing investigative focus Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Cognitive load regulation — applies structured file review protocols to manage simultaneous open files without allowing urgent files to crowd out attention to developing liability issues on others Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Team stress awareness — monitors team members for signs of compassion fatigue, burnout, or decision-making degradation under catastrophe or high-volume conditions and intervenes appropriately Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Intentional negotiation presence — enters settlement negotiations with deliberate situational awareness of power dynamics, emotional temperature, and positional anchoring to guide outcomes strategically Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
10Fortitude8 statements
Emerging
  1. Hostile claimant resilience — continues professional investigation activities after confrontational or threatening interactions with claimants or legal representatives Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Volume pressure persistence — maintains investigation quality and regulatory compliance during high-volume periods without cutting corners on required documentation Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Litigation endurance — sustains organized, proactive file management on claims in litigation for months or years without allowing file quality to deteriorate between legal milestones Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Ambiguous liability tolerance — advances investigation and reserves on files with genuinely unclear liability without forcing premature resolution to reduce uncertainty Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Catastrophe deployment resilience — performs effective claims investigation and customer service under field conditions during large-scale disasters, maintaining composure and decision quality over sustained periods Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Contested denial defense — upholds evidence-based claim denials through claimant appeals, regulatory complaints, and legal challenges without capitulating to pressure absent new evidence Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Organizational change leadership — guides the claims team through system migrations, restructuring, or regulatory overhauls with sustained performance and morale intact Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Prolonged fraud prosecution support — maintains complete, organized, and legally defensible claims files through multi-year fraud prosecution timelines, supporting law enforcement and legal counsel to final resolution Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Sources:Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
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Source anchors that ground each statement

Related titles
Accident Investigator · Adjuster · Adjustment Clerk · Auto Claims Adjuster (Automotive Claims Adjuster) · Auto Damage Claims Adjuster (Automotive Damage Claims Adjuster) · Benefit Authorizer · Bodily Injury Claims Adjuster · Bodily Injury Claims Examiner · Claims Account Specialist · Claims Adjuster · Claims Adjustor · Claims Agent
RAPIDS apprenticeships
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O*NET skills
Reading ComprehensionCritical ThinkingActive ListeningSpeakingJudgment and Decision MakingWritingComplex Problem SolvingMonitoringSocial PerceptivenessActive LearningCoordinationNegotiationService OrientationSystems AnalysisTime Management
Knowledge domains
Customer and Personal ServiceEnglish LanguageAdministrativeMathematicsComputers and ElectronicsLaw and GovernmentAdministration and ManagementEconomics and Accounting
Abilities
Written ComprehensionOral ComprehensionOral ExpressionInductive ReasoningDeductive ReasoningWritten ExpressionNear VisionProblem SensitivitySpeech ClarityInformation Ordering
Work styles
Attention to DetailDependabilityIntegrityCautiousnessPerseveranceStress Tolerance
Technology
Computer aided design CAD softwareEnterprise resource planning ERP softwareDocument management softwareInternet browser softwareFinancial analysis softwareExpert system softwareBilling and invoicing softwareOffice suite softwareAccess softwareInformation retrieval or search software
Tasks · seed anchors for statements
  1. Examine claims forms and other records to determine insurance coverage.
  2. Analyze information gathered by investigation and report findings and recommendations.
  3. Pay and process claims within designated authority level.
  4. Investigate, 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.
  5. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
  6. Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  7. Investigate and assess damage to property and create or review property damage estimates.
  8. Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims.
CIP education codes
51.071552.1701

Sources: O*NET v30.2 (CC BY 4.0), SkillsCrosswalk.com, LER.me, Anthropic Economic Index, SAFI (Jadhav & Danve, 2026), WEF Skills Taxonomy 2021, Pathsmith Durable Skills Framework. © 2026 EBSCOed.