Insurance Claims and Policy Processing Clerks SkillsPACK

11-50 employees

Finance

Insurance Claims and Policy Processing Clerks

Contract

In person

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Required skills

Identifies if a claim requires specialist handling and the resultant claims management process (e.g. fraud suspicions, a large loss)
Pays small claims
Organizes or works with detailed office or warehouse records, using computers to enter, access, search or retrieve data
Calculates premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards
Handles straightforward claims in line with organizational policies and procedures and own authority limits and adheres to organizational referral procedures
Follows company’s policy rules and any implemented changes
Transmits claims for payment or further investigation
Checks computations of interest accrued, premiums due, and settlement surrender on loan values
Prepare insurance claim forms or related documents, and reviews them for completeness
Obtains computer printout of policy cancellations, or retrieve cancellation cards from file
Reviews insurance policy to determine coverage
Establishes and maintains courteous client relationships with prospective and existing policyholders
Processes and records new insurance policies and claims
Compares information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met
Processes, prepares, and submits business or government forms, such as submitting applications for coverage to insurance carriers
Modifies, updates, or processes existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance
Examines letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes
Identifies which exclusions and policy conditions are standard and which are non-standard on a policy
Identifies whether a policy is in force and the next steps in processing a claim notification
Posts or attaches information to claim file
Contacts insured or other involved persons to obtain missing information
Participates in training from employer to stay current on legal and regulatory changes in the industry
Explains the ways that fraud may be committed by customers and knows common fraud indicators
Reviews all material representation to ensure accuracy of any necessary measurement data
Provides customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors
Input and maintain detailed and up-to-date claim files with data and analysis of coverage, damages, incident reports, correspondence, and related records
Identifies, investigates and resolves any issues relating to claims being handled in line with organizational policies and procedures
Applies insurance rating systems
Interviews clients and takes their calls to provide customer service and obtain information on claims
Advises clients when straightforward claims are settled and issues settlement checks when appropriate
Collects initial premiums and issues receipts
Enters insurance- and claims-related information into database systems
Transcribes data to worksheets, and enters data into computer for use in preparing documents and adjusting accounts
Educates customers about policies, including availability, eligibility, policy changes, transfers, claim processing, billing, and decisions
Demonstrates an understanding of mechanisms available for resolving claims settlement disputes (eg. arbitration and mediation) and when these are used
Complies with internal and external standards and requirements for reporting
Notifies insurance agent and accounting department of policy cancellation
Negotiates in a timely manner to provide cost effective solutions for the company and its customers within a range of everyday situations
Organizes or works with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled
Complies with company’s standards and customer service policies
Identifies the legal principles that may affect the claims settlement decision and takes the appropriate action
Demonstrates an understanding of the company’s key business objectives and how own role contributes to these
Calculates amount of claim
Reviews and verifies data, such as age, name, address, and principal sum and value of property, on insurance applications and policies
Manages claims based on set parameters and authority levels (e.g. by class of business, type of claim, below a set financial limit)
Provides policyholders with regular updates on the progress of their claims
Corresponds with insured or agent to obtain information or to inform them of account status or changes