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Insurance Claims Clerks
SOC Code: 43-9041.01

Obtain information from insured or designated persons for purpose of settling claim with insurance carrier.

Sample of reported job titles: Call Center Representative, Claim Processing Specialist, Claim Service Representative, Claim Technician, Claims Clerk, Claims Customer Service Representative (Claims CSR), Claims Processor, Claims Representative, Claims Service Representative, Claims Technician

Tasks

  • Enter claims information into database systems.
  • 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.
  • 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.
  • Pay small claims.
  • Apply insurance rating systems.

Technology Skills

  • Accounting software - Billing software
  • Data base user interface and query software - Alpha Software Alpha Five; Data entry software ; IBM Check Processing Control System CPSC; St. Paul Travelers e-CARMA (see all 7 examples)
  • Internet browser software - Web browser software
  • Medical software - Healthcare common procedure coding system HCPCS ; Medical condition coding software ; Medical procedure coding software
  • Office suite software - Microsoft Office
  • Presentation software - Microsoft PowerPoint
  • Spreadsheet software - Microsoft Excel
  • Word processing software - Microsoft Word

Tools Used

  • Desktop calculator - 10-key calculators
  • Desktop computers
  • Dictation machines
  • Personal computers

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.
  • English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
  • 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.
  • Computers and Electronics - Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • Mathematics - Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.

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.
  • Service Orientation - Actively looking for ways to help people.
  • Social Perceptiveness - Being aware of others' reactions and understanding why they react as they do.

Abilities

  • 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.
  • Written Comprehension - The ability to read and understand information and ideas presented in writing.
  • 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).
  • Speech Clarity - The ability to speak clearly so others can understand you.
  • 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).
  • Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
  • 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 there is a problem.
  • 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.
  • Category Flexibility - The ability to generate or use different sets of rules for combining or grouping things in different ways.

Interests

  • Interest code: CE
    • 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.

Work Context

  • Electronic Mail - 99% responded “Every day.”
  • Spend Time Sitting - 91% responded “Continually or almost continually.”
  • Telephone - 70% responded “Every day.”
  • Importance of Repeating Same Tasks - 59% responded “Extremely important.”
  • Indoors, Environmentally Controlled - 87% responded “Every day.”
  • Importance of Being Exact or Accurate - 60% responded “Extremely important.”
  • Contact With Others - 68% responded “Constant contact with others.”
  • Frequency of Decision Making - 68% responded “Every day.”
  • Work With Work Group or Team - 52% responded “Extremely important.”
  • Spend Time Making Repetitive Motions - 60% responded “Continually or almost continually.”
  • Structured versus Unstructured Work - 42% responded “Some freedom.”
  • Freedom to Make Decisions - 41% responded “Some freedom.”
  • Impact of Decisions on Co-workers or Company Results - 38% responded “Important results.”
  • Letters and Memos - 49% responded “Every day.”
  • Deal With External Customers - 49% responded “Extremely important.”
  • Face-to-Face Discussions - 34% responded “Every day.”
  • Time Pressure - 42% responded “Every day.”
  • Degree of Automation - 36% responded “Moderately automated.”
  • Deal With Unpleasant or Angry People - 27% responded “Every day.”
  • Coordinate or Lead Others - 30% responded “Very important.”
  • Responsibility for Outcomes and Results - 31% responded “Moderate responsibility.”

Education

Percentage of RespondentsEducation Level Required
45%High school diploma or equivalent
20%Associate's degree
17%Some college, no degree

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.
  • Concern for Others - Job requires being sensitive to others' needs and feelings and being understanding and helpful on the job.
  • 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.
  • Stress Tolerance - Job requires accepting criticism and dealing calmly and effectively with high stress situations.
  • Adaptability/Flexibility - Job requires being open to change (positive or negative) and to considerable variety in the workplace.
  • Initiative - Job requires a willingness to take on responsibilities and challenges.
  • Achievement/Effort - Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
  • Persistence - Job requires persistence in the face of obstacles.
  • Social Orientation - Job requires preferring to work with others rather than alone, and being personally connected with others on the job.
  • Analytical Thinking - Job requires analyzing information and using logic to address work-related issues and problems.
  • Leadership - Job requires a willingness to lead, take charge, and offer opinions and direction.
  • Innovation - Job requires creativity and alternative thinking to develop new ideas for and answers to work-related problems.

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.
  • Working Conditions - Occupations that satisfy this work value offer job security and good working conditions. Corresponding needs are Activity, Compensation, Independence, Security, Variety and Working Conditions.

Wages & Trends

  • Median wages (2017)
    • $18.65 hourly, $38,790 annual
  • Employment (2016)
    • 309,000 employees
  • Projected growth (2016-2026)
    • Faster than average (10% to 14%)
  • Projected job openings (2016-2026)
    • 35,600

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