What Is the Difference Between A Claims Adjuster and Claims Analyst?

Background Insurance Companies & Activities are Regulated

Insurance companies in most states are regulated by the state’s insurance department or division. These regulatory agencies are responsible for overseeing the insurance industry and ensuring that insurance companies comply with state laws and regulations. They have the authority to investigate insurance companies and take enforcement action against them if necessary.

Some of the ways in which insurance companies are regulated include:

1. Licensing: Insurance companies and insurance agents are required to be licensed by the state insurance regulatory agency in order to sell insurance in that state.
2. Solvency regulation: Insurance regulatory agencies monitor the financial stability of insurance companies and ensure that they have the financial resources to meet their policyholder obligations.
3. Rate and form regulation: Insurance regulatory agencies review and approve insurance rates and policy forms to ensure that they are fair and not discriminatory.
4. Consumer protection: Insurance regulatory agencies protect consumers by enforcing insurance laws and regulations, handling consumer complaints, and providing information and education to consumers about insurance.

Overall, the goal of insurance regulation is to protect consumers and promote a stable and competitive insurance market.

Insurance Adjusters

Insurance companies are heavily regulated and so are the insurance adjusters that work for them. For example, to become a claims adjuster in the state of Maine, you will need to meet the following requirements:

1. Obtain a high school diploma or GED.
2. Complete a claims adjuster training program or course. There are a variety of options available, including online courses, in-person seminars, and college-level courses. Some insurance companies may provide training for their own adjusters.
3. Obtain a claims adjuster license. In Maine, claims adjusters are required to be licensed by the Maine Department of Professional and Financial Regulation. To obtain a license, you will need to pass a written exam and pay a fee.
4. Maintain your license. Claims adjusters in Maine are required to complete continuing education courses in order to maintain their license.

To become a claims adjuster in the state of Illinois, you will need to meet the following requirements:

1. Obtain a high school diploma or GED.
2. Complete a claims adjuster training program or course. Options may include online courses, in-person seminars, and college-level courses. Some insurance companies may provide training for their own adjusters.
3. Obtain a claims adjuster license. In Illinois, claims adjusters are required to be licensed by the Illinois Department of Insurance. To obtain a license, you will need to pass a written exam and pay a fee.
4. Maintain your license. Claims adjusters in Illinois are required to complete continuing education courses in order to maintain their license.

It is also important to note that some insurance companies may have additional requirements for their claims adjusters, such as a college degree or experience in a related field.

Claims Analyst

Unlike insurance adjusters, claims analyst are not required to be licensed. The job does not required any advanced degree or education. Many companies that hire claims analysts do not even require prior experience in the industry. Most claims analyst jobs come with on the job training.

Why the differences between an insurance adjuster and claims analyst matters.

In the event of an overtime lawsuit, some employers may try to claim that claims adjusters are exempted from the FLSA because they fall under the “learned professional” category. What is this?

Under the Fair Labor Standards Act (FLSA), “learned professional” is a specific exemption category that applies to certain types of workers who are exempt from overtime pay. To qualify as a learned professional under the FLSA, an employee must meet the following criteria:

1. Be compensated on a salary basis at a rate of at least $684 per week.
2. Have a primary duty that consists of the performance of work requiring advanced knowledge, defined as work that is predominantly intellectual in character and which includes work requiring the consistent exercise of discretion and judgment.
3. The advanced knowledge must be in a field of science or learning, and must be customarily acquired by a prolonged course of specialized intellectual instruction.

Examples of occupations that may qualify as learned professionals under the FLSA include doctors, lawyers, and architects. However, it is important to note that the determination of whether a particular occupation qualifies as a learned profession depends on the specific duties and responsibilities of the job, rather than the job title.