Skills & Competencies for Claims Clerk I

Claims Clerk I job profile

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JOB SUMMARY for Claims Clerk I

Reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary.

JOB RESPONSIBILITIES for Claims Clerk I

Inputs claim information into system for processing. Verifies coverage eligibility. Calculates settlement amounts according to guidelines. Processes routine claim payments.

Claims Clerk I SALARY RANGE

BASE 50%
$40,171
TOTAL 50%
$40,992
Job Level
A01
Job Code
FA06000538
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor

Claims Clerk I Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Claims Clerk I skill and competencie below to view definitions.
INDUSTRY COMPETENCIES JOB FAMILY COMPETENCIES CORE COMPETENCIES
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6 hard skills or competencies (industry competencies) for Claims Clerk I

1 Industry Competency – Insurance Industry
Proficiency Level -1
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Cites different types of insurance policies and describes the advantages and disadvantages of each.
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Level 2 Behaviors
(Light Experience)
Compiles insurance quotes based on customer information and rates for insurance policies.
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Level 3 Behaviors
(Moderate Experience)
Applies risk management techniques to minimize financial impacts in insurance services.
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Level 4 Behaviors
(Extensive Experience)
Contributes to the development of insurance risk mitigation strategies to drive process improvements.
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Level 5 Behaviors
(Mastery)
Builds claim roadmaps and substantiation plans in compliance with insurance risk management practices.
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2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -1
Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Cites examples of the legal principles of insurance applicable to multiple types of insurance products.
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Level 2 Behaviors
(Light Experience)
Assists in assessing regulatory risks to ensure insurance operations meet compliance and regulatory obligations.
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Level 3 Behaviors
(Moderate Experience)
Adopts legal and regulatory initiatives to assess possible risks and maintain insurance solvency.
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Level 4 Behaviors
(Extensive Experience)
Directs the regulation of insurance products to ensure insurance policy provisions comply with state laws.
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Level 5 Behaviors
(Mastery)
Builds policy and regulatory tools to monitor and assess compliance levels with insurance laws and regulations.
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3 Claims Clerk I - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk I
Proficiency Level - 4
5 Competency for - Claims Clerk I
Proficiency Level - 5

2 general skills or competencies (Job family competencies) for Claims Clerk I

1 Job Family Competencies – Data Entry
Proficiency Level -2
Skill definition-Transcribing information into an electronic medium such as a computer or other electronic device.
Level 1 Behaviors
(General Familiarity)
Cites examples of the techniques and approaches used to improve the data entry process.
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Level 2 Behaviors
(Light Experience)
Assists in coding and verifying materials and resources for data processing entry.
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Level 3 Behaviors
(Moderate Experience)
Leverages data collection tools to enter and update collected information.
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Level 4 Behaviors
(Extensive Experience)
Collaborates with cross-functional teams to resolve escalated errors in data entry.
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Level 5 Behaviors
(Mastery)
Creates data entry protocols to monitor information consistency and integrity for positive business impacts.
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2 Job Family Competencies – Payment Processing
Proficiency Level -1
Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Lists major activities involved in payment processing.
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Level 2 Behaviors
(Light Experience)
Records the periodic processing of payables to handle payment processing.
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Level 3 Behaviors
(Moderate Experience)
Works with the relevant staff to minimize administrative burdens relating to payment processing.
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Level 4 Behaviors
(Extensive Experience)
Oversees the day-to-day operations related to payment processing in support of business activities.
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Level 5 Behaviors
(Mastery)
Leads the provision of invoice processing instruction and training for posting invoices for payment.
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3 Claims Clerk I - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk I
Proficiency Level - 4
5 Competency for - Claims Clerk I
Proficiency Level - 5

7 soft skills or competencies (core competencies) for Claims Clerk I

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -1
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Lists the typical processes of SOP development.
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Level 2 Behaviors
(Light Experience)
Supports the analysis of our business and operations processes for SOP design and development.
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Level 3 Behaviors
(Moderate Experience)
Researches new tools and techniques for SOP daily management.
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Level 4 Behaviors
(Extensive Experience)
Resolves complex issues arising from SOP practices; develops preventative solutions accordingly.
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Level 5 Behaviors
(Mastery)
Monitors industry for SOP trends and best practices; makes recommendations about those that benefit our business.
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2 Core Competencies – Attention to Detail
Proficiency Level -2
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Lists the traits of an employee showing great attention to detail.
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Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
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Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
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Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
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Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
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3 Claims Clerk I - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk I
Proficiency Level - 4
5 Competency for - Claims Clerk I
Proficiency Level - 5

Summary of Claims Clerk I skills and competencies

There are 6 hard skills for Claims Clerk I, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Claims Clerk I, Data Entry, Payment Processing.
7 soft skills for Claims Clerk I, Standard Operating Procedures (SOP), Attention to Detail, Maintaining Focus, etc.
While the list totals 15 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Clerk I, he or she needs to be proficient in Standard Operating Procedures (SOP), be proficient in Attention to Detail, and be proficient in Maintaining Focus.

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