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Major Group
3
Technicians and Associate Professionals
Sub-Major Group
33
Business and Administration Associate Professionals
Unit Group
3315
Valuers and Loss Assessors
Minor Unit Group
MASCO Code
3315-03
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Insurance Adjuster
Insurance Adjuster evaluates and investigates insurance claims to determine the insurer’s liability and the appropriate level of compensation under policy terms. They conduct inspections of damaged property or assess reported losses and injuries, gather and verify information from claimants and relevant parties, and prepare assessment reports to support settlement or denial decisions. The role ensures claims are handled fairly, accurately and in accordance with policy conditions, while identifying and addressing potential fraudulent or non-compliant claims.
Tasks
Investigate insurance claims by reviewing documents, inspecting damages, and interviewing relevant parties.
Assess the extent of damage or loss and determine liabilities covered by insurance policies.
Evaluate the value of property, equipment, personal items, or medical claims for insurance purposes.
Consult with experts such as doctors, mechanics, or contractors to verify claim details.
Identify and investigate potential fraudulent claims, referring to special investigations when necessary.
Prepare detailed reports and recommendations for claim approval, modification, or rejection, including settlement considerations.
Liaise and communicate with policyholders, legal representatives, repairers, and internal teams throughout the claims process.
Ensure claims processing complies with regulatory guidelines, company policies, and documentation standards.
Skills
Basic
Effective written and verbal communication, including multilingual capability, to liaise with claimants and stakeholders.
High attention to detail to ensure accuracy and detect discrepancies or potential fraud.
Organisational and time management skills to manage multiple claims efficiently within deadlines.
Sound decision-making and ethical judgment in handling confidential information and regulatory compliance.
Strong analytical and critical thinking to evaluate claims and interpret evidence.
Specific
Ability to analyse claims data and supporting evidence to determine validity and value.
Competence in conducting on-site inspections, technical assessments, and damage evaluations.
Familiarity with Malaysian insurance regulations and Bank Negara Malaysia guidelines.
Knowledge of insurance policy terms, conditions, and claims procedures.
Knowledge of medical terminology relevant to health and life insurance claims.
Negotiation and mediation within insurance policy limits.
Proficiency in claims management and processing systems.
Skill in drafting clear, detailed, and legally sound claim assessment reports.
Additional Info
QUALIFICATION
Diploma or equivalent
Related Courses
MASCO
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