actuarial science
The rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.
Loss adjusters treat and evaluate insurance claims by investigating the cases and determining liability and damage, in accordance with the policies of the insurance company. They interview the claimant and witnesses and write reports for the insurer where appropriate recommendations for the settlement are made. Loss adjusters' tasks include making payments to the insured following his claim, consulting damage experts and providing information via telephone to the clients.
Competences and skills
39 ESCO relationsEssential knowledge 5 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
3 competencesclaims procedures
The different procedures that are used to formally request a payment for a suffered loss from an insurance company.
principles of insurance
The understanding of the principles of insurance, including third party liability, stock and facilities.
Cross-sector
2 competencesinsurance law
The law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation of insurance claims and the business of insurance.
types of insurance
The various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.
Essential skills and competences 16 competences
Occupation specific
1 competencepropose settlements
Take into account the damage appraisal or incident and injury reports in order to suggest a settlement to insurance professionals which would settle the claim with the claimant, such as estimating repair costs for damages or a reimbursement of medical costs.
Sector-specific
9 competencesanalyse claim files
Check the claim from a customer and analyse the value of the lost materials, buildings, turnover or other elements, and judge the responsibilities of the different parties.
assess coverage possibilities
Examine the reports dealing with damage appraisal or injury examination in order to verify whether the insured's damages or injuries are covered in their insurance policies, and if they are to assess to which extent they are covered and what settlements the insurer may have to provide.
estimate damage
Estimate damage in case of accidents or natural disasters.
handle incoming insurance claims
Manage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the circumstances.
initiate claim file
Start up the process to file a claim for a customer or victim, based on the judgement of the damage and the responsibilities of the parties involved.
interview insurance claimants
Interview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in the insurance policy, as well as detect any fraudulous activities in the claims process.
manage claim files
Follow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close the file and give information to an authorised person or department when there is suspicion of fraud.
negotiate settlements
Negotiate with insurance companies and insurance claimants in order to facilitate agreement on a settlement which the insurance company has to provide for the claimant, such as covering repair costs for damages, taking into account the appraisal reports and the coverage assessment.
review insurance process
Analyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the case will not pose significant risk to the insurer or whether claims assessment was correct, and to assess the further course of action.
Cross-sector
6 competencescheck for damaged items
Identify products that have been damaged and report the situation.
compile appraisal reports
Compile full reports of appraisals of properties, businesses, or other goods and services being appraised using all the data gathered during the appraisal and valuation process, such as financial history, ownership, and developments.
document evidence
Document all evidence found on a crime scene, during an investigation, or when presented in a hearing, in a manner compliant with regulations, to ensure that no piece of evidence is left out of the case and that records are maintained.
manage claims process
Manage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.
organise a damage assessment
Organise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.
present evidence
Present evidence in a criminal or civil case to others, in a convincing and appropriate manner, in order to reach the right or most beneficial solution.
Optional knowledge 1 competence
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
0 competencesNo competences in this bucket.
Cross-sector
1 competencefraud detection
The techniques used to identify fraudulous activities.
Optional skills and competences 17 competences
Occupation specific
0 competencesNo competences in this bucket.
Sector-specific
4 competencesadvise on insurance policies
Advise on specific contracts and general insurance guidelines, such as the terms of coverage, the risks that are involved, the handling of claims, and terms of settlements.
assess customer credibility
Communicate with customers to assess whether their true intentions are in line with what they claim in order to eliminate any risks from a potential agreement with the customer.
classify insurance claims
Process incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handling, and to guaranee that the claim may proceed to the correct loss adjuster or other claims professionals.
collect property financial information
Collect information concerning the previous transactions involving the property, such as the prices at which the property had been previously sold and the costs that went into renovations and repairs, in order to obtain a clear image of the property's value.
Cross-sector
13 competencesanalyse financial risk
Identify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.
conduct financial audits
Evaluate and monitor the financial health, the operations and financial movements expressed in the financial statements of the company. Revise the financial records to ensure stewardship and governability.
create a financial plan
Develop a financial plan according to financial and client regulations, including an investor profile, financial advice, and negotiation and transaction plans.
create cooperation modalities
Prepare, determine and agree on the conditions for cooperation contracts with a company, by comparing products, following evolutions or shifts in the market and negotiating terms and prices.
determine cause of damage
Recognise damage and signs of corrosion, identify their cause and determine maintenance and repair procedures.
ensure cross-department cooperation
Guarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.
identify damage to buildings
Monitor the state of building exteriors in order to identify any possible damage and to assess the nature of the damage and treatment methods.
investigate occupational injuries
Assess, manage, and report cases of occupational illness, disease, or injury, establishing if this is a single case or if there is wider incidence.
listen to the stories of the disputants
Listen to the arguments of the parties involved in disputes in order to clarify misunderstandings and miscommunications among them.
manage contract disputes
Monitor issues that arise between the parties involved in a contract and provide solutions in order to avoid lawsuits.
obtain financial information
Gather information on securities, market conditions, governmental regulations and the financial situation, goals and needs of clients or companies.
prepare financial auditing reports
Compile information on audit findings of financial statements and financial management in order to prepare reports, point out improvement possibilities, and confirm governability.
provide information on properties
Provide information on the positive and negative aspects of a property and the practicalities concerning any financial transactions or insurance procedures; such as location, composition of the property, renovation or repair needs, the cost of the property and the costs related to insurance.