Employees of property/casualty insurers fulfill various roles such as adjuster, underwriter, and claims examiner. Because these individuals make important decisions about your insurance coverage, you should have a basic understanding of what they do.
Types of Insurance Companies
The functions performed at insurance companies vary somewhat depending on the method insurers use to distribute their products. Most insurers fall into one of the following three groups:
- Direct Writers. Sell policies directly to insurance buyers without the use of intermediaries (agents or brokers). Direct writers interface with customers mainly via the telephone or a website. An example is GEICO.
- Exclusive Agency Insurers. Sell their products through captive (exclusive) agents, meaning agents contracted to sell their products only. Examples are Farmers Insurance and State Farm.
- Independent Agency Insurers. Sell and service insurance policies through independent agents and brokers. Examples are Travelers and Chubb.
Insurance Company Employees
Here are the main jobs performed by employees of property/casualty insurance companies. As noted below, these jobs do not exist in all companies.
Customer Service Representative
Insurance companies that operate as direct writers sell policies through customer service representatives (CSRs). CSRs are employees of the insurer. They communicate with customers via the telephone, the Internet, or a local sales office. When a new customer seeks a policy, the CSR gathers information and provides a quote. After the policy is issued, the CSR remains the customer's primary contact for all matters related to the policy other than claims.
At exclusive agency insurers, the agents may be employees of the company or independent contractors. In either case, the agents serve as the primary intermediary between customers and the insurer. They provide quotes to insurance buyers, service existing policies, educate customers about available coverages, and help policyholders file claims.
Some insurers employ sales representatives to call on potential clients and market the company's products. In the past, many insurers employed marketing representatives who worked with independent agencies to generate business. Nowadays, many insurers rely on underwriters to perform the tasks previously fulfilled by marketing reps.
Underwriters review applications submitted by CSRs, agents or brokers and decide which applicants meet the insurer's underwriting guidelines. For example, suppose your independent agent has submitted an application on your behalf for a business auto policy. The underwriter studies the data in the application. He or she considers the age and condition of your vehicles, the manner in which the autos are used, your loss history, your employees' driving records, and other aspects of your business.
The underwriter uses the information he or she has gathered to determine your company's risk level (average, above average or worse than average). The underwriter's job doesn't end when you buy a policy. He or she will likely review your policy and any associated claim activity several months before its expiration date. The underwriter will decide whether to renew your policy and if so, the renewal premium.
Your risk level affects your premium. Good risks pay less than poor risks and vice versa.
Insurance adjusters interface with policyholders on matters related to claims. An adjuster may be an employee of the insurer or an independent contractor.
Once you have filed a claim, an insurance adjuster reviews the details of your loss and inspects any damaged property (yours or the claimant's). He or she interviews witnesses, claimants, physicians, police and other individuals who have information relevant to the claim. The adjuster reviews your policy to determine whether the loss is covered. He or she may negotiate a settlement with you or the claimant and authorize payments.
Claims examiners review claim information provided by adjusters to determine whether the claims have been handled properly. Examiners do not review every claim. They focus on those that are complex, severe, questionable or otherwise require extra attention. Examiners enter claim payments, reserve amounts, and other data into the insurer's computer system. They may interview witnesses, attorneys, physicians and others involved in the claim. Examiners keep track of claims until they are finalized and all costs have been verified.
Loss Control Representative
Many insurers offer risk control services to policyholders. A risk control employee may conduct a physical inspection of your buildings, vehicles and other insured property to evaluate it for hazards. He or she may also observe your employees at work to see whether they are performing their jobs safely and using proper protective equipment.
Once the inspection has been completed, the risk control worker prepares a report. The inspection report outlines existing hazards and provides recommendations on how you can reduce to eliminate them. The loss control employee forwards the inspection report to the underwriter, who uses the information to monitor your risks.
Some recommendations may be optional while others are mandatory, meaning you must make the recommended changes to retain your insurance coverage.
Many insurance policies (including virtually all workers compensation policies) are subject to an annual audit. Audits are performed by premium auditors. The auditor may collect the information he or she needs via the telephone or conduct a physical audit at your premises. In either case, the auditor will review the payroll, sales and other financial information you have provided to make sure it is accurate. The auditor will calculate your final premium and compare it to your initial (deposit) premium. If the two numbers differ, you may be charged an additional premium or receive a refund.
Actuaries determine the rates you pay for insurance. They use mathematical models, statistics and financial theories to predict future losses. They help insurers create new products by forecasting potential losses and developing appropriate rates. Actuaries must ensure that rates are competitive but high enough to generate a profit.