🛠️ Claims & Adjusting
Claims is where insurance becomes real. It is the sector responsible for investigating losses, interpreting coverage, coordinating experts, managing litigation, and ultimately determining how policies respond. Claims professionals sit at the intersection of law, finance, engineering, medicine, and human behavior — making this one of the most complex and consequential sectors in the insurance industry.
📘 What This Sector Covers
The Claims & Adjusting sector encompasses all activities related to the investigation, evaluation, negotiation, and resolution of insurance claims across every major line of business — property, liability, auto, workers compensation, professional liability, cyber, environmental, and more.
Claims professionals interpret policy language, determine coverage, coordinate experts, manage litigation, and ensure fair and timely resolution of losses. This sector is deeply technical, highly regulated, and central to the credibility of the insurance system.
🧩 Core Concepts in Claims & Adjusting
- 🕵️ Claims Investigation Fundamentals (Statements, Evidence, Documentation)
- ⚖️ Coverage Analysis & Reservation of Rights (Policy Interpretation)
- 🏚️ Property Claims Overview (Fire, Water, Collapse, CAT)
- 🚗 Liability Claims Overview (BI, PD, Negligence, Defense)
- 🦺 Workers Compensation Claims Fundamentals (Benefits, Medical, Return-to-Work)
- 💼 Litigation Management & Subrogation (Defense, Recovery, Strategy)
- 📊 Claims Reserving & Evaluation (Severity, Exposure, Settlement)
🎖️ Key Designations in This Sector
- AIC — Associate in Claims
- SCLA — Senior Claims Law Associate
- ARM — Associate in Risk Management
- CPCU — Chartered Property Casualty Underwriter
- WCCA — Workers Compensation Claims Associate
- WCCP — Workers Compensation Claims Professional
- CWCP — Certified Workers Compensation Professional
- MLIS — Management Liability Insurance Specialist
- CRIS — Construction Risk & Insurance Specialist
- ERIS — Energy Risk Insurance Specialist
🧑💼 Roles in This Sector
- Claims Adjusters (Property, Liability, Auto)
- Complex Claims Adjusters
- Workers Compensation Claims Specialists
- Subrogation Specialists
- Litigation Claims Specialists
- Claims Supervisors & Managers
- Forensic Accountants (Business Interruption & Complex Loss)
- Independent Adjusters & Third-Party Administrators (TPAs)
