Une journée de travail de chez soi pour un ajusteur en assurance !

Table of Contents

1. 🕵️ Introduction
2. 🖥️ A Day in the Life of a Desk Adjuster
   • 2.1 Logging into Systems and Clearing Tasks
   • 2.2 Checking for New Claims
   • 2.3 Preparing for Quality First Call (QFC)
   • 2.4 Updating the First Notice of Loss (FNOL)
   • 2.5 Calling the Insured and Scheduling an Inspection
   • 2.6 Working with the Field Adjuster
   • 2.7 Explaining Recoverable Depreciation
3. 💼 Part Two: Work from Home Claims Adjuster on a WCCS Deployment
   • 3.1 Completing Tasks Assigned by the Team Manager
   • 3.2 Dealing with Incoming Calls and Creating File Notes
   • 3.3 Working on Various Claims Activities
     • 3.3.1 Handling New Mail and QFCs
     • 3.3.2 Reconciliations and Supplements
     • 3.3.3 Releasing Recoverable Depreciation (RCBS)
     • 3.3.4 Writing Mile Letters and RORs
     • 3.3.5 Making Coverage Decisions
   • 3.4 Assisting with Customer Service and Meetings
4. 📚 Conclusion

🕵️ Introduction

Being a desk adjuster is an important role in the insurance industry, particularly when it comes to homeowner claims resulting from natural disasters or weather-related events. This article will give you an in-depth look at the day-to-day responsibilities of a desk adjuster, providing insights into their tasks, interactions, and key acronyms involved in the claims process.

🖥️ A Day in the Life of a Desk Adjuster

As a desk adjuster, each day starts with logging into various systems and clearing tasks. The morning routine is crucial to ensure the smooth flow of operations. Let's explore the typical tasks and activities involved:

2.1 Logging into Systems and Clearing Tasks

Upon arrival at the office, usually around 7:00 A.M., the desk adjuster starts their day by turning on the computer and logging into different systems. These systems include the main claim system, email system, team management system, and phone system. The adjuster typically has two phone logins to manage.

One of the initial tasks is to check voicemail and clear any time-sensitive phone messages. These messages often require immediate attention and may involve contacting the insured, agent's office, public adjuster, or even a contractor. Clearing these tasks promptly is essential to avoid being on the delinquent report, which should be avoided.

2.2 Checking for New Claims

After addressing the urgent tasks, the desk adjuster checks for any new claim assignments. This can involve brand new claims or reassignments. If it's a new claim, the adjuster prepares for a quality first call (QFC). The QFC is a significant step in the claims process, where the adjuster collects essential information about the insurance policy, coverage, deductible, and details about the incident from the insured.

To facilitate the QFC, the adjuster uses a template that includes a checklist of key information to cover during the call. This template ensures all necessary details are obtained, such as the insured's account of the incident and whether they were present when it happened. The information gathered during the call is then used to update the First Notice of Loss (FNOL).

2.3 Preparing for Quality First Call (QFC)

The quality first call (QFC) is a critical interaction between the desk adjuster and the insured. During the QFC call flow, the adjuster follows the QFC template, discussing coverages, deductibles, insurance responsibility, and collecting the insured's account of the incident.

It is essential for the adjuster to explain the terms and coverages clearly while also asking specific questions to gather information. The adjuster's goal is to obtain all the necessary details to update the FNOL accurately. The FNOL is a crucial report that provides detailed information about the damage, loss, and theft as reported by the insured. It marks the first step toward successfully processing an insurance claim.

2.4 Updating the First Notice of Loss (FNOL)

After the QFC call, the desk adjuster updates the FNOL based on the information gathered during the call. This involves documenting the damage, loss, and theft reported by the insured. Accurate and thorough reporting is essential to ensure the successful processing of the claim.

By updating the FNOL promptly, the desk adjuster sets the stage for the next steps in the claims process, such as scheduling an inspection and determining the claim's value.

2.5 Calling the Insured and Scheduling an Inspection

Once the FNOL is updated, the desk adjuster calls the insured again. This time, the purpose of the call is to schedule a field adjuster to go out and conduct an inspection. The field adjuster plays a crucial role in providing on-site information about the damage and assisting the desk adjuster in managing the claim effectively.

To ensure a smooth inspection process, the desk adjuster sets the inspection appointment around ten days after the initial call with the insured. This time frame allows the field adjuster enough time to visit the property, assess the damage, write the estimate, and proceed with the actual cash value (ACV) payment if applicable.

2.6 Working with the Field Adjuster

The field adjuster's contribution is invaluable to the desk adjuster's role. The field adjuster acts as a front line in gathering accurate and detailed information about the claim. They provide first-hand knowledge about the property damage, which the desk adjuster relies on to manage the claim's life cycle effectively.

Collaborating closely with the field adjuster, the desk adjuster ensures a smooth flow of information and updates the FNOL or other claim documentation based on the field adjuster's findings. This partnership is crucial in accurately assessing the damage, determining coverage, and processing the claim efficiently.

2.7 Explaining Recoverable Depreciation

After the inspection and assessment phase, the desk adjuster follows up with the insured to explain the recoverable depreciation reconciliation process. This process calculates the differences between the insurance carrier's assessment and the contractor's estimate.

Recoverable depreciation refers to the amount equal to the replacement cost minus depreciation of the damaged or stolen property at the time of the loss. It is an important factor to consider when settling the claim. Clear communication and explanation of how the recoverable depreciation is calculated help the insured understand the claim settlement process better.

💼 Part Two: Work from Home Claims Adjuster on a WCCS Deployment

In the second part of this article, we will delve into the experiences and responsibilities of a work-from-home claims adjuster during a WCCS deployment. Let's discover what their day looks like and the tasks they handle:

3.1 Completing Tasks Assigned by the Team Manager

Starting at around 9:00 A.M., the work-from-home claims adjuster receives directives from their team manager or Associate Vendor Manager (AVM). These directives usually come in the form of a spreadsheet listing claims that require attention. The AVM expects the team to complete these tasks by noon.

However, due to the dynamic nature of the job, it's important to note that completing all tasks by the given deadline may not always be possible. Throughout the day, the adjuster may receive numerous phone calls from different parties, such as insureds, contractors, public adjusters, mortgage lenders, FEMA, other claim handlers, and customer service representatives. Responding to these calls and addressing the callers' concerns is an integral part of the adjuster's job.

3.2 Dealing with Incoming Calls and Creating File Notes

Handling incoming calls requires the adjuster to open a claim file and engage in discussions with the callers. These conversations cover various topics related to the claim, such as policy coverage, claim updates, documentation requests, or general inquiries. It is crucial for the adjuster to take detailed file notes and schedule follow-up tasks on their calendar to address these matters later.

While these unexpected calls can disrupt the adjuster's planned schedule, each call is important and requires attention. Addressing the concerns and questions of various stakeholders is a fundamental aspect of the claims handling process.

3.3 Working on Various Claims Activities

The remainder of the day involves working on different claims-related activities, which contribute to the overall claims management process. Let's take a closer look at some of these tasks:

3.3.1 Handling New Mail and QFCs

The adjuster dedicates time to reviewing and processing new correspondence related to the claims. This includes mail received from insureds, contractors, public adjusters, or any other relevant party. Additionally, they evaluate and respond to Quality First Calls (QFCs) made by the insured during the day. These QFCs serve as opportunities to address their concerns and provide guidance.

3.3.2 Reconciliations and Supplements

The adjuster also focuses on reconciling differences between the insurance carrier's assessment and the contractor's estimate. This reconciliation process ensures accurate claim settlements and helps manage disputes or discrepancies.

Furthermore, handling supplements becomes an important part of the adjuster's day. Supplements involve requesting additional funding or revising the estimate when additional damages or necessary repairs are identified during the claim process.

3.3.3 Releasing Recoverable Depreciation (RCBS)

Within the claims process, the adjuster deals with releasing recoverable depreciation (RCBS) based on the claim settlement and the depreciation calculation from the inspection phase. Releasing recoverable depreciation involves updating the claim file and reimbursing the insured for the recoverable depreciation amount they are entitled to.

3.3.4 Writing Mile Letters and RORs

Writing Mile Letters (confirmation letters) is another task the adjuster handles. These letters serve as formal communication with the insured, acknowledging key stages in the claims process and providing necessary information.

The adjuster is also responsible for writing Reports of Recommendations (RORs) when required. These reports document specific activities or recommendations related to the claim, such as suggested coverage changes or handling complex claim scenarios.

3.3.5 Making Coverage Decisions

As a claim owner, the desk adjuster plays a pivotal role in making coverage decisions. This involves reviewing policy documentation, considering the facts and information gathered during the claims process, and ensuring compliance with applicable insurance regulations. Making accurate coverage decisions is crucial to reaching fair and satisfactory claim settlements.

3.4 Assisting with Customer Service and Meetings

Throughout the day, the adjuster may receive directions from the client to log into the customer service phone system for specific periods to assist with customer inquiries or act as a backup. This demonstrates the adjuster's flexibility and willingness to support customer service efforts when needed.

Furthermore, the work-from-home claims adjuster participates in a weekly team meeting to align with their colleagues and share updates. Additionally, they attend a weekly vendor meeting to collaborate with external vendors involved in the claims process. These meetings foster effective communication and ensure smooth cooperation among all stakeholders.

📚 Conclusion

Being a desk adjuster involves a wide range of tasks and responsibilities, starting from logging into systems and clearing tasks to handling claims, communicating with insureds and other stakeholders, managing inspections, making coverage decisions, reconciling assessments, and providing excellent customer service. The role requires adaptability, efficient time management, effective communication, and a thorough understanding of the claims process.

The day in the life of a desk adjuster is filled with both planned and unexpected activities. This dynamic environment ensures that no two days are the same, bringing various challenges and opportunities for growth. Despite the demanding nature of the job, desk adjusters play a crucial role in helping insureds navigate the claims process and recover from unforeseen events.

If you have any questions or would like to share your thoughts, I would love to hear from you.