How to Be Claims Clerk - Job Description, Skills, and Interview Questions

Jan 21, 2022 / 5 Minutes Read / By Albert

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The role of a Claims Clerk is to process and manage insurance claims. This role requires a high level of accuracy, meticulous attention to detail, and the ability to multi-task. As a result, Claims Clerks must be organized and have excellent communication skills.

In addition, they must have an in-depth understanding of the insurance industry and its regulations, as well as a strong understanding of customer service principles. When Claims Clerks successfully fulfill their duties, insurance companies benefit from improved customer service, reduced costs, and fewer errors. This in turn leads to increased customer satisfaction, improved business relations with clients, and increased revenue for the company.

Steps How to Become

Obtain a high school diploma or GED. Most employers prefer to hire individuals with at least a high school diploma or equivalent.
Pursue a degree in business administration, accounting, or a related field. Although a college degree is not required to become a claims clerk, having one can help you advance in the field.
Gain experience in a related field. Many employers prefer to hire individuals with some experience in handling customer service, billing, or insurance claims.
Obtain an insurance license. In some states, claims clerks must be licensed before they can process claims.
Research potential employers. Claims clerks are employed by insurance companies, hospitals, and other organizations that process claims.
Apply for available positions. After researching potential employers and finding available positions, submit your application and resume to the employer.
Prepare for an interview. Many employers will require applicants to participate in an interview before they are hired. Prepare by researching the organization and practicing your responses to potential questions.
Complete any necessary training. After you are hired, you may need to complete additional training to learn the organization's policies and procedures for handling claims.

In order to stay ahead and capable as a claims clerk, it is important to stay up-to-date on the latest industry trends, regulations, and procedures. Keeping an eye on the latest news and developments in the field will help you understand the newest rules and regulations that may affect your work. it is helpful to continue your education and stay current with the ever-evolving technology and software.

Doing so will help you stay abreast of the advances in claims processing and other related tasks. Finally, networking with other claims clerks can be beneficial as this can lead to collaboration and the sharing of ideas and best practices. By staying informed, continuing your education, and networking with colleagues, you can stay ahead and capable as a claims clerk.

You may want to check Receptionist/Clerk, Customer Service Representative/Clerk, and Payroll Clerk for alternative.

Job Description

Process and review insurance claims forms for accuracy and completeness.
Enter claim information into computer systems for processing.
Monitor the progress of claims to ensure timely payment.
Respond to inquiries from customers, insurance companies, and other parties involved in claims.
Contact insurance companies and other parties involved in claims to follow up on outstanding issues.
Maintain detailed records of all claims activity.
Assist in resolving disputes regarding claims.
Prepare reports and summaries of claims activity.
Ensure compliance with all applicable laws and regulations.
Perform other duties as assigned.

Skills and Competencies to Have

Excellent organizational skills
Strong attention to detail
Ability to work in a fast-paced environment
Working knowledge of medical insurance plans and terminology
Ability to multitask and prioritize
Excellent communication skills, both verbal and written
Proficiency in data entry and related software
Ability to maintain confidential information
Ability to interpret and explain claims policies and procedures
Knowledge of applicable laws and regulations related to claims processing

Having excellent organizational skills is essential for a Claims Clerk. They must be able to organize paperwork, maintain files, and keep records in an accurate and systematic manner. They must also be able to communicate effectively with fellow colleagues, insurance companies, and customers.

Without these skills, a Claims Clerk could easily become overwhelmed by paperwork and could potentially cause delays in processing claims. This could lead to potential lawsuits or monetary losses for the company. Furthermore, a lack of organizational skills could result in mistakes being made on insurance forms and applications, leading to costly errors and omissions.

As such, the ability to prioritize tasks and stay on top of deadlines is essential for a Claims Clerk to ensure that all claims are processed efficiently and accurately.

Records Management Clerk, Shipping Clerk Supervisor, and Office Clerk are related jobs you may like.

Frequent Interview Questions

What experience do you have with customer service and claims processing?
How do you ensure accuracy when completing claims paperwork?
What challenges have you faced with claims processing and how did you overcome them?
What strategies do you use to prioritize tasks and manage multiple claims?
What methods do you use to maintain updated records on claims?
How do you stay organized while managing a large number of claims?
What steps do you take to ensure customer satisfaction with the claims process?
How do you handle customer inquiries and complaints regarding the claims process?
What experience do you have dealing with insurance companies regarding claims?
How do you keep up with changes in regulations regarding claims processing?

Common Tools in Industry

Document Management System. A computer system that stores, organizes, and tracks documents. (e. g. Microsoft SharePoint)
Accounting Software. Software used to record and track financial transactions. (e. g. QuickBooks)
Spreadsheet Software. Allows users to create and manipulate data in tabular form. (e. g. Microsoft Excel)
Word Processing Software. Used to create, format, and edit text documents. (e. g. Microsoft Word)
Claims Processing Software. Used to automate the process of managing and tracking claims. (e. g. ClaimVantage)
Database Software. Used to store, manage, and query large amounts of data. (e. g. Oracle Database)
Imaging Software. Used to capture, store, and edit digital images. (e. g. Adobe Photoshop)
Form Builder Software. Used to create, manage, and store electronic forms. (e. g. Adobe FormsCentral)
Claim Adjustment Software. Used to adjust claims and ensure compliance with regulations. (e. g. CAPSYS)
Claims Analytics Software. Used to analyze claims data for better decision making. (e. g. ClaimIQ)

Professional Organizations to Know

National Association of Insurance Commissioners (NAIC)
American Association for Justice (AAJ)
American Bar Association (ABA)
National Association of Insurance and Financial Advisors (NAIFA)
International Association of Risk and Compliance Professionals (IARCP)
Claims and Litigation Management Alliance (CLM)
National Association of Professional Surplus Lines Offices (NAPSLO)
American Insurance Association (AIA)
Risk and Insurance Management Society (RIMS)
The Institutes RiskStream Collaborative

We also have Shipping Clerk, Reception Clerk, and Data Processing Clerk jobs reports.

Common Important Terms

Liability. An obligation, such as a debt or legal responsibility, to which one party (debtor) is legally bound to another (creditor).
Indemnity. A legal agreement by which one party agrees to compensate another for loss or damage caused by the formers negligence or breach of contract.
Negligence. Failure to use reasonable care and caution in performing an act or providing a service, resulting in harm or damage to another person or property.
Damages. Monetary compensation awarded to a person who has suffered a loss or injury due to the negligence or wrongful act of another.
Statute of Limitations. A legal term that defines the period of time within which a person can bring a lawsuit against another party.
Litigation. The process of resolving a dispute through the legal system.
Settlement. A resolution between two parties in which one agrees to pay the other an agreed sum of money in order to avoid court proceedings.
Subrogation. The legal right of an insurance company to step into the shoes of an insured and pursue a third party for damages.

Frequently Asked Questions

Q1: What is a Claims Clerk? A1: A Claims Clerk is a professional who handles the processing of insurance claims. They are responsible for investigating, verifying, and processing insurance claims, as well as providing customer service and support to claimants. Q2: What duties are typically associated with a Claims Clerk? A2: Typical duties of a Claims Clerk include collecting and verifying information from claimants, determining the validity of claims, processing claims, preparing and maintaining documents, and providing customer service to claimants. Q3: What qualifications are typically required to become a Claims Clerk? A3: To become a Claims Clerk, one typically needs to have a high school diploma or equivalent, as well as previous experience in customer service or insurance. Additionally, most employers require strong communication and organizational skills, as well as knowledge of insurance regulations and procedures. Q4: What are the typical working hours for a Claims Clerk? A4: Working hours for a Claims Clerk typically vary depending on the employer and the needs of the organization; however, most Claims Clerks work full-time during regular business hours. Q5: How much does a Claims Clerk usually earn? A5: The salary of a Claims Clerk typically ranges from $30,000 - $50,000 per year, depending on experience and the organization.