Example SOPs: Adjustor

Adjustor SOPs

Creating Standard Operating Procedures for your Adjustor work can be difficult and take time. That’s why we’ve created these example Adjustor SOPs so you can jumpstart your SOP creation process. We want to help you set up your Insurance systems and processes by taking these sample SOPs and building out your own SOPs template library. By having all your Insurance procedures in one place, your team will have the information they need at all times. Let’s look at some Adjustor SOP examples.

Adjustor SOP Examples

1. Claims Intake SOP: The purpose of this SOP is to outline the process for receiving and recording new insurance claims. It includes instructions for gathering necessary information from the claimant, verifying policy details, and assigning a claim number. The scope of this SOP covers all incoming claims and ensures a consistent and efficient intake process. The Claims Intake Specialist is responsible for following this SOP. Reference: Claims Processing SOP.

2. Claims Investigation SOP: This SOP details the steps involved in investigating insurance claims to determine their validity and coverage. It includes guidelines for gathering evidence, interviewing involved parties, and assessing damages. The scope of this SOP covers all claims under investigation and ensures a thorough and fair assessment. The Claims Investigator is responsible for following this SOP. Reference: Claims Intake SOP, Claims Processing SOP.

3. Claims Processing SOP: The purpose of this SOP is to outline the procedures for processing insurance claims once they have been investigated and approved. It includes instructions for calculating claim amounts, coordinating with other departments, and issuing payments. The scope of this SOP covers all approved claims and ensures a streamlined and accurate processing system. The Claims Processor is responsible for following this SOP. Reference: Claims Intake SOP, Claims Investigation SOP.

4. Policy Review SOP: This SOP outlines the process for reviewing insurance policies to determine coverage and exclusions. It includes guidelines for analyzing policy language, interpreting clauses, and consulting legal resources if needed. The scope of this SOP covers all policy reviews and ensures a consistent and accurate assessment. The Policy Review Specialist is responsible for following this SOP. Reference: Claims Investigation SOP.

5. Settlement Negotiation SOP: The purpose of this SOP is to provide guidelines for negotiating settlements with claimants or their representatives. It includes instructions for assessing claim values, considering policy limits, and engaging in effective communication. The scope of this SOP covers all settlement negotiations and ensures a fair and efficient resolution process. The Settlement Negotiator is responsible for following this SOP. Reference: Claims Investigation SOP, Claims Processing SOP.

6. Subrogation SOP: This SOP outlines the procedures for pursuing subrogation claims, which involve recovering claim costs from responsible third parties. It includes guidelines for identifying potential subrogation opportunities, gathering evidence, and initiating legal actions if necessary. The scope of this SOP covers all subrogation claims and ensures a proactive approach to cost recovery. The Subrogation Specialist is responsible for following this SOP. Reference: Claims Investigation SOP, Claims Processing SOP.

7. Fraud Detection SOP: The purpose of this SOP is to establish protocols for detecting and investigating potential insurance fraud. It includes instructions for recognizing red flags, conducting thorough investigations, and collaborating with law enforcement agencies. The scope of this SOP covers all claims suspected of fraudulent activity and ensures a diligent approach to fraud prevention. The Fraud Investigator is responsible for following this SOP. Reference: Claims Investigation SOP.

8. Customer Service SOP: This SOP outlines the procedures for providing exceptional customer service to policyholders and claimants. It includes guidelines for handling inquiries, addressing complaints, and maintaining professionalism. The scope of this SOP covers all customer interactions and ensures a positive and consistent experience. The Customer Service Representative is responsible for following this SOP. Reference: Claims Intake SOP, Claims Processing SOP.

9. Quality Assurance SOP: This SOP establishes the process for conducting quality assurance checks on claim files to ensure compliance with company policies and industry regulations. It includes guidelines for reviewing documentation, assessing accuracy, and providing feedback to adjustors. The scope of this SOP covers all claim files and ensures a high standard of quality and compliance. The Quality Assurance Specialist is responsible for following this SOP. Reference: Claims Intake SOP, Claims Investigation SOP, Claims Processing SOP.

10. Training and Development SOP: The purpose of this SOP is to outline the procedures for training and developing adjustors within the insurance company. It includes guidelines for onboarding new adjustors, providing ongoing training, and promoting professional growth. The scope of this SOP covers all adjustors and ensures a knowledgeable and skilled workforce. The Training and Development Manager is responsible for following this SOP. Reference: Claims Intake SOP, Claims Investigation SOP, Claims Processing SOP

Adjustor SOP Templates

Looking for SOP templates for your Adjustor work? We’ve got you covered. You can build out your company SOPs using the sample SOP information above (added to our template) or our team can put together a starter SOPs template based on your Adjustor work. Get in touch if you’ve got questions about the quickest way to build out your Insurance SOPs library.