Insurance Claims and Policy Processing Clerk 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.
Insurance Claims and Policy Processing Clerk is Also Know as
In different settings, Insurance Claims and Policy Processing Clerk is titled as
- Claims Adjudicator
- Claims Analyst
- Claims Clerk
- Claims Customer Service Representative (Claims CSR)
- Claims Processor
- Claims Representative (Claims Rep)
- Claims Technician (Claims Tech)
- Insurance Analyst
- Policy Analyst
- Underwriting Assistant
Education and Training of Insurance Claims and Policy Processing Clerk
Insurance Claims and Policy Processing Clerk is categorized in Job Zone Two: Some Preparation Needed
Experience Required for Insurance Claims and Policy Processing Clerk
Some previous work-related skill, knowledge, or experience is usually needed. For example, a teller would benefit from experience working directly with the public.
Education Required for Insurance Claims and Policy Processing Clerk
These occupations usually require a high school diploma.
Degrees Related to Insurance Claims and Policy Processing Clerk
- Bachelor in General Office Occupations and Clerical Services
- Associate Degree Courses in General Office Occupations and Clerical Services
- Masters Degree Courses in General Office Occupations and Clerical Services
Training Required for Insurance Claims and Policy Processing Clerk
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.
Related Ocuupations
Some Ocuupations related to Insurance Claims and Policy Processing Clerk in different industries are
- Customer Service Representatives
- Eligibility Interviewers, Government Programs
- Credit Authorizers, Checkers, and Clerks
- Billing and Posting Clerks
- Bookkeeping, Accounting, and Auditing Clerks
- Loan Interviewers and Clerks
- Office Clerks, General
- Correspondence Clerks
- Brokerage Clerks
- New Accounts Clerks
- Claims Adjusters, Examiners, and Investigators
- Insurance Sales Agents
- Insurance Underwriters
- Medical Records Specialists
- Receptionists and Information Clerks
- Bill and Account Collectors
- Sales Representatives of Services, Except Advertising, Insurance, Financial Services, and Travel
- Medical Secretaries and Administrative Assistants
- Payroll and Timekeeping Clerks
- Loan Officers
What Do Insurance Claims and Policy Processing Clerk do?
- 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.
- Review insurance policy to determine coverage.
- Process and record new insurance policies and claims.
- Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Correspond with insured or agent to obtain information or to inform them of account status or changes.
- Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.
- Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.
- Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
- Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.
- Notify insurance agent and accounting department of policy cancellation.
- Pay small claims.
- Process, prepare, and submit business or government forms, such as submitting applications for coverage to insurance carriers.
- Collect initial premiums and issue receipts.
- Check computations of interest accrued, premiums due, and settlement surrender on loan values.
- Interview clients and take their calls to provide customer service and obtain information on claims.
- Obtain computer printout of policy cancellations, or retrieve cancellation cards from file.
- Compose business correspondence for supervisors, managers, and professionals.
- Apply insurance rating systems.
- Calculate premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards.
- Enter insurance- and claims-related information into database systems.
- Modify, update, or process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
- Organize or work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.
Qualities of Good Insurance Claims and Policy Processing Clerk
- 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.
- Speech Clarity: The ability to speak clearly so others can understand you.
- 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).
- Oral Expression: The ability to communicate information and ideas in speaking so others will understand.
- Deductive Reasoning: The ability to apply general rules to specific problems to produce answers that make sense.
- Written Expression: The ability to communicate information and ideas in writing so others will understand.
- Information Ordering: The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
- Problem Sensitivity: The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
- Category Flexibility: The ability to generate or use different sets of rules for combining or grouping things in different ways.
- Inductive Reasoning: The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
- Selective Attention: The ability to concentrate on a task over a period of time without being distracted.
- Perceptual Speed: The ability to quickly and accurately compare similarities and differences among sets of letters, numbers, objects, pictures, or patterns. The things to be compared may be presented at the same time or one after the other. This ability also includes comparing a presented object with a remembered object.
- Mathematical Reasoning: The ability to choose the right mathematical methods or formulas to solve a problem.
- Number Facility: The ability to add, subtract, multiply, or divide quickly and correctly.
- Flexibility of Closure: The ability to identify or detect a known pattern (a figure, object, word, or sound) that is hidden in other distracting material.
- Time Sharing: The ability to shift back and forth between two or more activities or sources of information (such as speech, sounds, touch, or other sources).
- Far Vision: The ability to see details at a distance.
- Memorization: The ability to remember information such as words, numbers, pictures, and procedures.
- Speed of Closure: The ability to quickly make sense of, combine, and organize information into meaningful patterns.
- Fluency of Ideas: The ability to come up with a number of ideas about a topic (the number of ideas is important, not their quality, correctness, or creativity).
- Originality: The ability to come up with unusual or clever ideas about a given topic or situation, or to develop creative ways to solve a problem.
- Auditory Attention: The ability to focus on a single source of sound in the presence of other distracting sounds.
- Visual Color Discrimination: The ability to match or detect differences between colors, including shades of color and brightness.
- Trunk Strength: The ability to use your abdominal and lower back muscles to support part of the body repeatedly or continuously over time without "giving out" or fatiguing.
- Visualization: The ability to imagine how something will look after it is moved around or when its parts are moved or rearranged.
- Hearing Sensitivity: The ability to detect or tell the differences between sounds that vary in pitch and loudness.
- Finger Dexterity: The ability to make precisely coordinated movements of the fingers of one or both hands to grasp, manipulate, or assemble very small objects.
- Control Precision: The ability to quickly and repeatedly adjust the controls of a machine or a vehicle to exact positions.
- Arm-Hand Steadiness: The ability to keep your hand and arm steady while moving your arm or while holding your arm and hand in one position.
- Wrist-Finger Speed: The ability to make fast, simple, repeated movements of the fingers, hands, and wrists.
- Manual Dexterity: The ability to quickly move your hand, your hand together with your arm, or your two hands to grasp, manipulate, or assemble objects.
- Dynamic Strength: The ability to exert muscle force repeatedly or continuously over time. This involves muscular endurance and resistance to muscle fatigue.
- Multilimb Coordination: The ability to coordinate two or more limbs (for example, two arms, two legs, or one leg and one arm) while sitting, standing, or lying down. It does not involve performing the activities while the whole body is in motion.
- Spatial Orientation: The ability to know your location in relation to the environment or to know where other objects are in relation to you.
- Depth Perception: The ability to judge which of several objects is closer or farther away from you, or to judge the distance between you and an object.
- Speed of Limb Movement: The ability to quickly move the arms and legs.
- Reaction Time: The ability to quickly respond (with the hand, finger, or foot) to a signal (sound, light, picture) when it appears.
- Rate Control: The ability to time your movements or the movement of a piece of equipment in anticipation of changes in the speed and/or direction of a moving object or scene.
- Response Orientation: The ability to choose quickly between two or more movements in response to two or more different signals (lights, sounds, pictures). It includes the speed with which the correct response is started with the hand, foot, or other body part.
- Extent Flexibility: The ability to bend, stretch, twist, or reach with your body, arms, and/or legs.
- Stamina: The ability to exert yourself physically over long periods of time without getting winded or out of breath.
- Peripheral Vision: The ability to see objects or movement of objects to one's side when the eyes are looking ahead.
- Static Strength: The ability to exert maximum muscle force to lift, push, pull, or carry objects.
- Glare Sensitivity: The ability to see objects in the presence of a glare or bright lighting.
- Sound Localization: The ability to tell the direction from which a sound originated.
- Dynamic Flexibility: The ability to quickly and repeatedly bend, stretch, twist, or reach out with your body, arms, and/or legs.
- Gross Body Coordination: The ability to coordinate the movement of your arms, legs, and torso together when the whole body is in motion.
- Gross Body Equilibrium: The ability to keep or regain your body balance or stay upright when in an unstable position.
- Explosive Strength: The ability to use short bursts of muscle force to propel oneself (as in jumping or sprinting), or to throw an object.
- Night Vision: The ability to see under low-light conditions.
Tools Used by Insurance Claims and Policy Processing Clerk
- 10-key calculators
- Desktop computers
- Dictation machines
- Personal computers
Technology Skills required for Insurance Claims and Policy Processing Clerk
- Account management software
- Alpha Software Alpha Five
- Automated information system software
- Billing software
- Claim processing system software
- Database software
- GroupMe
- Healthcare common procedure coding system HCPCS
- IBM Check Processing Control System CPSC
- IBM Lotus Notes
- Insurance rating software
- InSystems Calligo Enterprise
- Medical condition coding software
- Medical procedure coding software
- MicroFocus GroupWise
- Microsoft Access
- Microsoft Excel
- Microsoft Internet Explorer
- Microsoft Office software
- Microsoft Outlook
- Microsoft PowerPoint
- Microsoft Windows
- Microsoft Word
- Policy issuance system software
- Spreadsheet software
- St. Paul Travelers e-CARMA
- Web browser software
- Word processing software
- Xactware Xactimate