Insurance Claims and Policy Processing Clerks


Also called : Claim Processing Specialist, Claims Clerk, Claims Customer Service Representative (Claims CSR), Claims Processor, Claims Representative, Enrollment Representative, Insurance Analyst, Policy Service C

What they do


Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives.

On the job, one would


  • Prepare insurance claim forms or related documents, and review them for completeness.

  • Calculate amount of claim.

  • Post or attach information to claim file.

  • Transmit claims for payment or further investigation.

  • Contact insured or other involved persons to obtain missing information.

KNOWLEDGE


  • Customer and Personal Service
    Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.

  • Administrative
    Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.

  • English Language
    Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

  • Computers and Electronics
    Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.

SKILLS


  • Active Listening
    Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

  • Reading Comprehension
    Understanding written sentences and paragraphs in work-related documents.

  • Speaking
    Talking to others to convey information effectively.

  • Critical Thinking
    Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.

  • Writing
    Communicating effectively in writing as appropriate for the needs of the audience.

ABILITIES


  • Written Comprehension
    The ability to read and understand information and ideas presented in writing.

  • Oral Comprehension
    The ability to listen to and understand information and ideas presented through spoken words and sentences.

  • Oral Expression
    The ability to communicate information and ideas in speaking so others will understand.

  • Speech Recognition
    The ability to identify and understand the speech of another person.

  • Near Vision
    The ability to see details at close range (within a few feet of the observer).

PERSONALITY

People interested in this work, will do well at jobs that need;

  • Attention to Detail
    Job requires being careful about detail and thorough in completing work tasks.

  • Integrity
    Job requires being honest and ethical.

  • Dependability
    Job requires being reliable, responsible, and dependable, and fulfilling obligations.

  • Cooperation
    Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.

  • Self-Control
    Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.

  • Independence
    Job requires developing one's own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.

  • Initiative
    Job requires a willingness to take on responsibilities and challenges.

  • Stress Tolerance
    Job requires accepting criticism and dealing calmly and effectively with high-stress situations.

  • Concern for Others
    Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.

  • Achievement/Effort
    Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.

TECHNOLOGY

  • Accounting software

  • Data base user interface and query software

  • Document management software

  • Electronic mail software

  • Financial analysis software

  • Instant messaging software

  • Internet browser software

  • Medical software

  • Office suite software

  • Presentation software

  • Spreadsheet software

EDUCATION AND TRAINING

  • Preparation

    Some Preparation Needed

  • Education

    High school diploma.

  • Experience

    Some previous work-related skill, knowledge, or experience is usually needed.

  • Jobtraining

    Employees in these occupations need anywhere from a few months to one year of working with experienced employees. A recognized apprenticeship program may be associated with these occupations.

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