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)
Describes the processes and rate standards for calculating the amount for insurance claims.
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Level 2 Behaviors
(Light Experience)
Gathers clients' financial information for the preparation of insurance contracts.
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Level 3 Behaviors
(Moderate Experience)
Performs thorough investigation and analysis of insurance claims to prevent fraudulent activities.
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Level 4 Behaviors
(Extensive Experience)
Leads the digitization and automation of insurance-related services to drive business transformation.
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Level 5 Behaviors
(Mastery)
Develops loss control practices to reduce financial exposure and risks in insurance operations.
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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)
Describes the importance of compliance programs in maintaining an insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Documents compliance complaints to track and escalate possible legal violations and ensure prompt resolution.
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Level 3 Behaviors
(Moderate Experience)
Executes market conduct exams to verify the adherence of insurance operations to laws and regulations.
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Level 4 Behaviors
(Extensive Experience)
Reviews root causes of regulatory deficiencies to create corrective action plans and ensure adherence.
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Level 5 Behaviors
(Mastery)
Develops an insurance regulatory framework to promote consumers' protection and achieve policy objectives.
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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)
Documents key concepts and components from the data entry manual.
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Level 2 Behaviors
(Light Experience)
Compiles records to accurately enter data on record management systems.
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Level 3 Behaviors
(Moderate Experience)
Prepares for the possibility of wasting time, money, and resources by analyzing accurate and timely data.
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Level 4 Behaviors
(Extensive Experience)
Engages in the development of data entry procedures to drive successful data entry system implementation.
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Level 5 Behaviors
(Mastery)
Develops new processes, methods, and procedures to improve the accuracy of data entry services.
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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)
Discusses various payment processing rules and regulations.
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Level 2 Behaviors
(Light Experience)
Enters relevant information into the system for accurate payment processing.
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Level 3 Behaviors
(Moderate Experience)
Performs the electronic payment processing of transactions for our business.
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Level 4 Behaviors
(Extensive Experience)
Ensures the accurate recording of relevant data for all payment processing transactions.
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Level 5 Behaviors
(Mastery)
Develops an organizational structure to manage the processing of invoices efficiently.
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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)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Documents the SOP drafts and outlines for final approval.
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Level 3 Behaviors
(Moderate Experience)
Initiates SOP revisions to support continuous improvement of processes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates the benefits and drawbacks of a specific SOP; oversees the corresponding enhancements.
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Level 5 Behaviors
(Mastery)
Establishes formal policies and procedures to guide the our SOP practices.
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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)
Identifies the procedures for making sure that results are mistake-free.
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Level 2 Behaviors
(Light Experience)
Processes limited amounts of detailed information with reasonable accuracy.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes the accuracy of data and details.
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Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
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Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
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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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