Mayer Hoffman MC Cann PC - Mark Luttrell Cpa

Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much.

Claims adjusters, appraisers, examiners, and investigators typically do the following:

• Investigate, evaluate, and settle insurance claims
• Determine whether the insurance policy covers the loss claimed
• Decide the appropriate amount the insurance company should pay
• Ensure that claims are not fraudulent
• Contact claimants' doctors or employers to get additional information on questionable claims
• Confer with legal counsel on claims when needed
• Keep claims files, such as records of settled claims and an inventory of claims requiring detailed analysis
• Negotiate settlements
• Authorize payments

What insurance adjusters, examiners, and investigators do varies by the type of insurance company they work for. They must know a lot about what their company insures. For example, workers in property and casualty insurance must know housing and construction costs to properly evaluate damage from floods or fires. Workers in health insurance must be able to determine which types of treatments are medically necessary and which are questionable. 

Some claims adjusters work as self-employed public adjusters.

Often, they are hired by claimants who prefer not to rely on the insurance company's adjuster. The goal of adjusters working for insurance companies is to save as much money for the company as possible. The goal of a public adjuster working for a claimant is to get the highest possible amount paid to the claimant.

Sometimes, self-employed adjusters are hired by insurance companies in place of hiring adjusters as regular employees. In this case, the self-employed adjusters work in the interest of the insurance company.

Adjusters inspect property damage to determine how much the insurance company should pay for the loss. The property they inspect could be a home, a business, or an automobile.

They interview the claimant and witnesses, inspect the property, and do additional research, such as look at police reports. Adjusters may consult with other workers, such as accountants, architects, construction workers, engineers, lawyers, and physicians, who can offer a more expert evaluation of a claim.

They gather information--including photographs and statements, either written or recorded audio or video--and put it in a report that claims examiners use to evaluate the claim. When the examiner approves policyholder's claim, the claims adjuster negotiates with the claimant and settles the claim.

If the claimant contests the outcome of the claim or the settlement, adjusters work with attorneys and expert witnesses to defend the insurer's position.

Appraisers estimate the cost or value of an insured item. Most appraisers who work for insurance companies and independent adjusting firms are auto damage appraisers. They inspect damaged vehicles after an accident and estimate the cost of repairs. This information then goes to the adjuster, who puts the estimated cost of repairs into the settlement.

Claims examiners review claims after they are submitted to ensure that proper guidelines have been followed by claimants and adjusters. They may assist adjusters with complicated claims or when, for example, a natural disaster occurs and the volume of claims increases.

Most claims examiners work for life or health insurance companies. Examiners who work for health insurance companies review health-related claims to see whether the costs are reasonable, given the diagnosis. After they review the claim, they authorize appropriate payment, deny the claim, or refer the claim to an investigator.

Examiners who work for life insurance companies review the causes of death and pay particular attention to accidents, because most life insurance companies pay additional benefits if a death is accidental. Examiners also may review new applications for life insurance policies to make sure the applicants have no serious illnesses that would make them a high risk to insure.

Insurance investigators handle claims in which the company suspects fraudulent or criminal activity such as arson, staged accidents, or unnecessary medical treatments. The severity of insurance fraud cases varies, from claimants overstating vehicle damage to complicated fraud rings. Investigators often do surveillance work. For example, in the case of a fraudulent workers' compensation claim, an investigator may covertly watch the claimant to see if he or she does activities that would be ruled out by injuries stated in the claim.

Cost estimators collect and analyze data to estimate the time, money, resources, and labor required for product manufacturing, construction projects, or services. Some specialize in a particular industry or product type.

Cost estimators typically do the following:

• Consult with industry experts to discuss estimates and resolve issues
• Identify and quantify cost factors, such as production time and raw material, equipment, and labor expenses
• Travel to job sites to gather information on materials needed, labor requirements, and other factors 
• Read blueprints and technical documents to prepare estimates
• Collaborate with engineers, architects, owners, and contractors on estimates
• Use sophisticated computer software to calculate estimates 
• Evaluate a product's cost effectiveness or profitability
• Recommend ways to make a product more cost effective or profitable
• Prepare estimates for clients and other business managers
• Develop project plans for the duration of the project

Accurately predicting the cost, size, and duration of future construction and manufacturing projects is vital to the survival of any business. Cost estimators' calculations give managers or investors this information.

When making calculations, estimators analyze many inputs to determine how much time, money, and labor a project needs, or how profitable it will be. These estimates have to take many factors into account, including allowances for wasted material, bad weather, shipping delays, and other factors that can increase costs and lower profitability.

Cost estimators use sophisticated computer software, including database, simulation, and complex mathematical programs. Cost estimators often use a computer database with information on the costs of other similar projects.

General contractors usually hire cost estimators for specific parts of a large construction project, such as estimating the electrical work or the excavation phase. In such cases, the estimator calculates the cost of the construction phase for which the contractor is responsible, rather than calculating the cost of the entire project. The general contractor usually also has a cost estimator who calculates the total project cost by analyzing the bids that the subcontractors' cost estimators prepared.

Some estimators are hired by manufacturers to analyze certain products or processes.

The following are the two primary types of cost estimators:

Construction cost estimators estimate construction work. More than half of all cost estimators work in the construction industry. They may, for example, estimate the total cost of building a bridge or a highway. They may identify direct costs, such as raw materials and labor requirements, and set a timeline for the project. Although many work directly for construction firms, some work for contractors, architects, and engineering firms.

Manufacturing cost estimators calculate the costs of developing, producing, or redesigning a company's goods and services. For example, a cost estimator working for a home appliance manufacturer may determine whether a new type of dishwasher will be profitable to manufacture.

Some manufacturing cost estimators work in software development. Many high-technology products require a considerable amount of computer programming, and the costs of software development are difficult to calculate.  

Two other groups also sometimes do cost estimating in their jobs. Operations research, production control, cost, and price analysts who work for government agencies may do significant amounts of cost estimating in the course of their usual duties. Construction managers also may spend considerable time estimating costs. For more information, see the profiles on operations research analysts and construction managers.

Archivists appraise, edit, and maintain permanent records and historically valuable documents. Many perform research on archival material.

Archivists typically do the following:

• Create and maintain accessible computer archives and databases
• Organize and classify archival records to make it easy to find materials
• Authenticate and appraise historical documents and archival materials
• Provide reference services and help for users
• Direct workers who help arrange, exhibit, and maintain collections
• Safeguard records by copying to film, videotape, disk, or computer formats
• Preserve and maintain documents and objects
• Set and administer policy guidelines concerning public access to materials
• Locate new materials and direct their acquisition and display

Archivists preserve many documents and records for their importance, potential value, or historical significance. Most archivists coordinate educational and public outreach programs, such as tours, workshops, lectures, and classes. Some work with the boards of institutions to administer plans and policies. In addition, archivists may research topics or items relevant to their collections.

Some archivists specialize in an area of history, such as colonial history, so they can more accurately determine which records in that area should be kept and should become part of the archives. Archivists also may work with specialized forms of records, such as manuscripts, electronic records, websites, photographs, maps, motion pictures, or sound recordings.

Archivists usually use computers to generate and maintain archival records. Professional standards for handling electronic archival records are still evolving. However, computer capabilities will continue to expand and more records will be stored and exhibited electronically, providing both increased access and better protection for archived documents.

Archives technicians help archivists organize, maintain, and provide access to historical documentary materials.

Bookkeeping, accounting, and auditing clerks produce financial records for organizations. They record financial transactions, update statements, and check financial records for accuracy.

Bookkeeping, accounting, and auditing clerks typically do the following:

• Use bookkeeping software as well as online spreadsheets and databases
• Enter (post) financial transactions into the appropriate computer software
• Receive and record cash, checks, and vouchers
• Put costs (debits) as well as income (credits) into the software, assigning each to an appropriate account
• Produce reports, such as balance sheets (costs compared to income), income statements, and totals by account
• Check figures, postings, and reports for accuracy
• Reconcile or note and report any differences they find in the records

The records that bookkeeping, accounting, and auditing clerks work with include expenditures (money spent), receipts (money that comes in), accounts payable (bills to be paid), accounts receivable (invoices, or what other people owe the organization), and profit and loss (a report that shows the organization's financial health).

Workers in this occupation have a wide range of tasks. Some in this occupation are full-charge bookkeeping clerks who maintain an entire organization's books. Others are accounting clerks who handle specific tasks.

These clerks use basic mathematics (adding, subtracting) throughout the day.

As organizations continue to computerize their financial records, many bookkeeping, accounting, and auditing clerks use specialized accounting software, spreadsheets, and databases. Most clerks now enter information from receipts or bills into computers, and the information is then stored electronically. They must be comfortable using computers to record and calculate data.

The widespread use of computers also has enabled bookkeeping, accounting, and auditing clerks to take on additional responsibilities, such as payroll, billing, purchasing (buying), and keeping track of overdue bills. Many of these functions require clerks to communicate with clients.

Bookkeeping clerks, also known as bookkeepers, often are responsible for some or all of an organization's accounts, known as the general ledger. They record all transactions and post debits (costs) and credits (income).

They also produce financial statements and other reports for supervisors and managers. Bookkeepers prepare bank deposits by compiling data from cashiers, verifying receipts, and sending cash, checks, or other forms of payment to the bank.

In addition, they may handle payroll, make purchases, prepare invoices, and keep track of overdue accounts.

Accounting clerks typically work for larger companies and have more specialized tasks. Their titles, such as accounts payable clerk or accounts receivable clerk, often reflect the type of accounting they do.

Often, their responsibilities vary by level of experience. Entry-level accounting clerks may enter (post) details of transactions (including date, type, and amount), add up accounts, and determine interest charges. They also may monitor loans and accounts to ensure that payments are up to date.

More advanced accounting clerks may add up and balance billing vouchers, ensure that account data is complete and accurate, and code documents according to an organization's procedures.

Auditing clerks check figures, postings, and documents to ensure that they are mathematically accurate and properly coded. They also correct or note errors for accountants or other workers to fix.

Accountants and auditors prepare and examine financial records. They ensure that financial records are accurate and that taxes are paid properly and on time. Accountants and auditors assess financial operations and work to help ensure that organizations run efficiently. 

Accountants and auditors typically do the following:

• Examine financial statements to be sure that they are accurate and comply with laws and regulations
• Compute taxes owed, prepare tax returns, and ensure that taxes are paid properly and on time
• Inspect account books and accounting systems for efficiency and use of accepted accounting procedures
• Organize and maintain financial records
• Assess financial operations and make best-practices recommendations to management
• Suggest ways to reduce costs, enhance revenues, and improve profits

In addition to examining and preparing financial documentation, accountants and auditors must explain their findings. This includes face-to-face meetings with organization managers and individual clients, and preparing written reports.

Many accountants and auditors specialize, depending on the particular organization that they work for. Some organizations specialize in assurance services (improving the quality or context of information for decision makers) or risk management (determining the probability of a misstatement on financial documentation). Other organizations specialize in specific industries, such as healthcare.

Some workers with a background in accounting and auditing teach in colleges and universities. For more information, see the profile on postsecondary teachers.

The four main types of accountants and auditors are the following:

Public accountants do a broad range of accounting, auditing, tax, and consulting tasks. Their clients include corporations, governments, and individuals.

They work with financial documents that clients are required by law to disclose. These include tax forms and balance sheet statements that corporations must provide potential investors. For example, some public accountants concentrate on tax matters, advising corporations about the tax advantages of certain business decisions or preparing individual income tax returns.

External auditors review clients' financial statements and inform investors and authorities that the statements have been correctly prepared and reported.

Public accountants, many of whom are Certified Public Accountants (CPAs), generally have their own businesses or work for public accounting firms.

Some public accountants specialize in forensic accounting, investigating financial crimes, such as securities fraud and embezzlement, bankruptcies and contract disputes, and other complex and possibly criminal financial transactions. Forensic accountants combine their knowledge of accounting and finance with law and investigative techniques to determine if an activity is illegal. Many forensic accountants work closely with law enforcement personnel and lawyers during investigations and often appear as expert witnesses during trials.

Management accountants, also called cost, managerial, industrial, corporate, or private accountants, record and analyze the financial information of the organizations for which they work. The information that management accountants prepare is intended for internal use by business managers, not by the general public.

They often work on budgeting and performance evaluation. They may also help organizations plan the cost of doing business. Some may work with financial managers on asset management, which involves planning and selecting financial investments such as stocks, bonds, and real estate.

Government accountants maintain and examine the records of government agencies and audit private businesses and individuals whose activities are subject to government regulations or taxation. Accountants employed by federal, state, and local governments ensure that revenues are received and spent in accordance with laws and regulations.

Internal auditors check for mismanagement of an organization's funds. They identify ways to improve the processes for finding and eliminating waste and fraud. The practice of internal auditing is not regulated, but the Institute of Internal Auditors (IIA) provides generally accepted standards.

Information technology auditors are internal auditors who review controls for their organization's computer systems, to ensure that the financial data comes from a reliable source.