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%
$40,074
TOTAL 50%
$40,891
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)
Explains the policy conditions of various insurance contracts and products.
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Level 2 Behaviors
(Light Experience)
Provides prompt responses to clients’ insurance-related questions and concerns.
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Level 3 Behaviors
(Moderate Experience)
Utilizes various tools and technologies to optimize insurance claims turnaround cycles.
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Level 4 Behaviors
(Extensive Experience)
Provides recommendations for improving methods and procedures to enhance insurance claims handling.
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Level 5 Behaviors
(Mastery)
Leads the deployment of strategic approaches to address complex insurance risk management programs.
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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)
Discusses the importance of insurance regulations in protecting clients' financial security and assets.
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Level 2 Behaviors
(Light Experience)
Gathers and interprets policy contracts to understand insurance legal and regulatory standards.
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Level 3 Behaviors
(Moderate Experience)
Maintains financial and market regulation to validate insurance's accounting methods and procedures.
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Level 4 Behaviors
(Extensive Experience)
Sets guidelines to promote fairness and transparency in financial markets in providing insurance products.
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Level 5 Behaviors
(Mastery)
Develops compliance and risk management standards to manage overall insurance legal and regulatory environment.
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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)
Explains codes and instructions in performing data entry.
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Level 2 Behaviors
(Light Experience)
Conducts basic data entry tasks to ensure information accuracy and completion.
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Level 3 Behaviors
(Moderate Experience)
Uses various technologies in performing data entry transactions to improve the overall efficiency.
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Level 4 Behaviors
(Extensive Experience)
Facilitates timely entry of data into the system to correct data incompatibilities.
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Level 5 Behaviors
(Mastery)
Establishes data entry systems to detect data errors and initiate corrective action plans.
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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)
Explains the essential payment processing terms to clients and the staff.
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Level 2 Behaviors
(Light Experience)
Receives invoices from vendors for payment processing.
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Level 3 Behaviors
(Moderate Experience)
Provides technical information for procedures related to payment processing.
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Level 4 Behaviors
(Extensive Experience)
Manages the payment processing tasks for our business.
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Level 5 Behaviors
(Mastery)
Establishes and implements controls for the payment processing team.
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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)
Identifies our internal and external sources for the SOPs we need.
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Level 2 Behaviors
(Light Experience)
Participates in the implementation of new SOPs and enhancement of existing ones.
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Level 3 Behaviors
(Moderate Experience)
Maintains the accuracy of SOPs to provide consistent guidance in our workplace.
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Level 4 Behaviors
(Extensive Experience)
Leverages the use of SOPs to solve business and operation problems.
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Level 5 Behaviors
(Mastery)
Keeps abreast of industry regulation and its effect on our internal SOPs.
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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 best practices and tools to maintain high accuracy and thoroughness in the workplace.
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Level 2 Behaviors
(Light Experience)
Uses checklists to ensure that information goes out error-free.
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Level 3 Behaviors
(Moderate Experience)
Sets up processes to ensure delivery of high-quality work.
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Level 4 Behaviors
(Extensive Experience)
Employs techniques for motivating personnel to meet or exceed accuracy goals.
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Level 5 Behaviors
(Mastery)
Leads the creation of tools for enhancing and assuring accuracy.
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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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