People in Insurance
In spite of the stereotypical concept of people working in insurance being dishonest or exceedingly dull, I have found the General Insurance industry to be filled with intelligent, dedicated, and highly principled people. Of course there are always exceptions to this. In this section, you will see some of the roles insurance people may work in.
Insurance sales agents, brokers or advisors are the people who can give direct advice to their customers. As such, people who sell insurance generally need to be licensed by their regional insurance regulatory organization. While there are insurance companies that sell directly with their own insurance agents, many other salespeople do not. Brokers may sell insurance from several different companies. Agents may work for companies that have a special arrangement to sell insurance from specific insurance companies under various classes of insurance. Regardless of the company an insurance advisor may work for, the work setting may be in a retail setting, a contact centre, or as outside sellers - meeting with clients and potential clients directly.
The primary purpose of an insurance advisor's role is to sell insurance policies. At the same time, the advisor also needs to offer a certain level of protection to the insurance companies they are selling by studying insurance applications, and doing their best to ensure they are accurate. An insurance advisor also needs to sell according to the company requirements for issuing policies - sometimes an advisor needs no special permission to sell a policy - and other times where they need to contact the underwriters for the insurance company in order to get authorization to sell a policy.
In addition to selling, an insurance advisor also is bound to certain professional and legal requirements to offer advice, and to properly ascertain the potential risks to the customer and customer's property in order to offer appropriate coverage for the customer. In effect, the insurance advisor is obligated to have both the customer and the insurance company's best interests at heart - even if it means the advisor needs to tell the customer that (s)he is not in a position to sell a policy - and thereby potentially suggest trying a competitor. As such, the insurance advisor must act with utmost good faith to both the customer as well as the insurance company.
As the initial and primary point of contact, an insurance advisor usually only begins a relationship with a client on selling an insurance policy. The client will look to the advisor (either personally, or as a company representative) to get advice, make changes to coverage, cancel coverage, or to initially report a claim. As such, an advisor is frequently not just a sales person, but also the client's advocate.
Underwriters are the people who work behind the scenes, determining whether to accept a policy application submitted to them by an insurance advisor. It frequently is the underwriter who may make special stipulations on a policy, or determine not to offer coverage on an application. In a nutshell, the underwriter is the person working for the insurance company who evaluates the risk of taking on coverage of a specific policy or potential policy. The way they determine this is by keeping and enforcing the insurance company's underwriting rules, and by having a detailed and thorough understanding of the policy wording.
The underwriter's primary concern is to be an advocate for the insurance company: protecting it from risks they consider to be too high. At the same time, they do try to work with the insurance advisor in order to place coverage in most cases. Underwriters generally don't give or offer advice - and so they don't talk directly to clients. In a way, the insurance advisors are their direct customers.
An adjuster or claims processor is the front-line person who handles claims for the insurance company. The primary job of the adjuster is to ensure the insurance company looks after their customers when they need help under their coverage, while still trying to keep the cost to the company manageable. Adjusters are the ones who conducts the initial investigation of claims, taking information about the claim such as what happened, where it happened, how it happened, etc. Based on this information, the claims adjuster needs to fully understand the insurance policy for the company (s)he is working for, and then determines if the claim is actually covered under the policy. If it is, then the adjuster coordinates the cost estimates and the subsequent repair/replacement according to the claims policy of the insurance company. As they do not sell insurance, adjusters generally cannot give insurance advice.
Adjusters tend to come in various skill levels, and so each level may be permitted to handle claims up to a certain amount before they need to call for guidance. In the course of working on a claim. The adjuster will be in contact directly from the customer, the insurance advisor who sold the policy, repair companies doing any work, as well as appraisers and field adjusters who may be dispatched to see the damage in person. It's also possible that the adjuster may have contact with underwriters to clarify interpretations of the policy wording, a special investigator in the event of potentially suspicious circumstances, a Claims Manager or Claims Examiner for direction on larger claims, witnesses, any other insurance companies that may be involved, and possibly even the company's legal team.
Adjusters frequently are responsible for working on many claims at once: perhaps 100 or more at a given time. Because of this, it is essential for an adjuster to be very good with time management - and it is always in the adjuster's best interest to complete claims quickly. Claims adjusters can be either inside or outside adjusters: inside adjusters work exclusively in an office or call-centre setting, while an outside (also known as a field or road) adjuster will go to actually see the damage, and meet face to face with people in the course of their investigation. While sometimes it is the inside adjuster who handles a claim, they may work with a field adjuster to help as their eyes and ears.
A claims manager is a person who is the leader of a claims unit. This person will be responsible for the smooth functioning of his/her claims office, and may be responsible for hiring adjusters, and may have some influence on the company's claims policy. The claims manager may frequently become involved in large claims, providing direction, as well as with complex claims. In the event of complaints, it may be the claims manager who will become involved. If a claims team does not have a claims examiner, the claims manager will take on aspects of that role as well.
A claims examiner is generally a senior staff member in a claims office who oversees a number of claims being handled by adjusters - providing instructions and guidance to adjusters in how to proceed with their claims. They may audit adjusters' work: ensuring claims are handled in a way that is consistent with the company policies, local laws, and regulatory organizations. In this sort of capacity, a claims examiner does not generally work on specific claims (other than by offering advice to the adjuster) or speak to customers directly.
Depending on the insurance company, the title of claims examiner may simply be given to senior adjusters. When this is the case, the guidance and auditing functions may be handled directly by claims supervisors or Claims Managers.
Actuaries are the people who look at different things that affect risk for the company in broad terms - such as geographical areas and building construction, among many other factors. The actuary then takes statistical data and other information for these broad subjects, and creates the different formulas that create insurance rates. Their job is to keep the insurance company profitable and also competitive. Effectively, an actuary is a mathematician and statistician who never looks at individual situations or policies, but only on the very big picture for the company.