Insurance Claim and Policy Processing Clerk

Also called: Account Administrator, Agency Service Representative, Billing and Insurance Coordinator, Call Center Representative, Cancellation Clerk

Varies

estimated salary

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.

  • 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 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.
Work Context

Work Context information for this career will be available soon.

Work Activities
  • Interacting 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.
  • Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
  • Communicating with Persons Outside Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
  • Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
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Detailed Work Activities
  • Check data for recording errors.
  • Prepare documentation for contracts, transactions, or regulatory compliance.
  • Calculate costs of goods or services.
  • Compile data or documentation.
  • Send information, materials or documentation.
  • Discuss account status or activity with customers or patrons.
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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.
Clerical
  • Knowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and 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.

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.
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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.
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Personality

People interested in this work like activities that include ideas, thinking, and figuring things out.
They do well at jobs that need:
  • Achievement/Effort
  • Persistence
  • Initiative
  • Leadership
  • Cooperation
  • Concern for Others
  • Social Orientation
  • Self Control
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Technology

You might use software like this on the job:

Data base user interface and query software
  • Microsoft Access Hot Technology
  • Data entry software Hot Technology
  • Policy issuance system software
  • St. Paul Travelers e-CARMA
  • Alpha Software Alpha Five
  • Automated information system software
  • Claim processing system software
  • Database software
  • IBM Check Processing Control System CPSC
Spreadsheet software
  • Microsoft Excel Hot Technology
  • Spreadsheet software
Medical software
  • Medical condition coding software Hot Technology
  • Healthcare common procedure coding system HCPCS Hot Technology
  • Medical procedure coding software
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