Insurance Claims Processing Job Description

March 19, 20120 Comments

Insurance claims processing Job Profile and Description

Insurance claims processing clerk decides on benefit claims and processes the claims for payment. He analyzes and answers questions regarding claim settlement, which may include method of payment, deductible amounts, or reason for denial

Duties and Responsibilities

  • The insurance claims processing clerk gets the required information from both internal and external sources to establish whether the claim is complete and valid
  • He has to coordinate the benefits information and go through the details mentioned
  • He also has to compare the data on claim application and other documents like death certificate, doctor’s statement with the policy file that the company has
  • He analyzes the claims to determine the extent of liability and according to policy rules he settles claims with claimants
  • He has to thoroughly research the claims as required and for the protection of the company
  • He interacts with agents and claimants, meets them in person to correct errors on claim forms and to investigate doubtful entries
  • After making necessary investigations, he pays the claimant the amount due to him.

Skills and Specifications

  • Insurance policy processing clerks must have good analytical skills and through knowledge of rules and regulations related to insurance
  • He must have good communication and interpersonal skills to be able to interact with customers from different walks of life and answer their queries
  • They must pay attention to details and work hard under pressure to meet deadlines
  • Math skills and basic technical knowledge are necessary as most of the work is computerized nowadays

Education and Qualifications

Although there are no specific degrees for this line, one may go for a bachelor’s degree in commerce and courses in finance; banking, sales and accounting. There some specific private courses which train in this field. However, on the job experience is more important to stand out in this field.

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