Insurance Claims and Policy Processing Clerks
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.
Sample of reported job titles:
Claim Processing Specialist, Claims Clerk, Claims Customer Service Representative (Claims CSR), Claims Processor, Claims Representative, Enrollment Representative, Insurance Analyst, Policy Service Coordinator, Policy Services Representative, Processing Clerk
Occupation-Specific Information
Tasks
- 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.
Technology Skills
- Accounting software:Account management software,Billing software
- Data base user interface and query software:Alpha Software Alpha Five,Automated information system software,Claim processing system software,Database software,IBM Check Processing Control System CPSC,Microsoft Access,Policy issuance system software,St. Paul Travelers e-CARMA
- Document management software:InSystems Calligo Enterprise
- Electronic mail software:IBM Lotus Notes,MicroFocus GroupWise,Microsoft Outlook
- Financial analysis software:Insurance rating software
Occupational Requirements
Work Activities
- Working with Computers:Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
- Getting Information:Observing, receiving, and otherwise obtaining information from all relevant sources.
- Communicating with Supervisors, Peers, or Subordinates:Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Processing Information:Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
- Evaluating Information to Determine Compliance with Standards:Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
Detailed Work Activities
- Answer telephones to direct calls or provide information.
- Calculate costs of goods or services.
- Calculate financial data.
- Check data for recording errors.
- Code data or other information.
Worker Requirements
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.
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.
Worker Characteristics
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).
Interests
- Conventional:Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
- Enterprising:Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
- Social:Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
Work Values
- Relationships:Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
- Support:Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
- Independence:Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
Work Styles
- 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.
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