Skills & Competencies for Claims Clerk II

Claims Clerk II job profile

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JOB SUMMARY for Claims Clerk II

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

JOB RESPONSIBILITIES for Claims Clerk II

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

Claims Clerk II SALARY RANGE

BASE 50%
$47,286
TOTAL 50%
$48,568
Job Level
A02
Job Code
FA06000539
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor

Claims Clerk II 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 II 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 II

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)
Makes necessary adjustments to insurance policies to meet customer needs.
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Level 4 Behaviors
(Extensive Experience)
Handles complex insurance losses through negotiation of favorable claims settlements with insurance companies.
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Level 5 Behaviors
(Mastery)
Develops and establishes risk reduction best practices to prevent fraudulent claims transactions.
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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 basic structure of insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Complies with insurance legal and regulatory principles to safeguard the rights and interests of the insured.
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Level 3 Behaviors
(Moderate Experience)
Analyzes existing legal and regulatory standards to address errors affecting insurance policies.
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Level 4 Behaviors
(Extensive Experience)
Improves legal procedures for licensing intermediaries or producers to prevent penalties.
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Level 5 Behaviors
(Mastery)
Designs compliance strategies and programs to prevent violations of statutes, regulations, and policies.
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3 Claims Clerk II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk II
Proficiency Level - 4
5 Competency for - Claims Clerk II
Proficiency Level - 5

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

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)
Describes the importance of accurate data entry to maintain a productive recordkeeping system.
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Level 2 Behaviors
(Light Experience)
Collects data by sorting information to prepare a source for computer entry.
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Level 3 Behaviors
(Moderate Experience)
Performs complicated data entry functions for deficiencies and checks images.
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Level 4 Behaviors
(Extensive Experience)
Drives a zero error rate in data entry by enabling data profiling to reduce data redundancy.
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Level 5 Behaviors
(Mastery)
Designs data quality verification process to consistently meet timelines of data entry operations.
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2 Job Family Competencies – Payment Processing
Proficiency Level -2
Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Discusses the best practices in payment processing.
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Level 2 Behaviors
(Light Experience)
Compiles all the invoices and enters them into the system for accurate payment processing.
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Level 3 Behaviors
(Moderate Experience)
Partners with the relevant departments to provide support matters related to payment processing.
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Level 4 Behaviors
(Extensive Experience)
Drives the entire supporting process that provides accurate payment processing.
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Level 5 Behaviors
(Mastery)
Designs a highly scalable and standard functional architecture for payment processing.
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3 Claims Clerk II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk II
Proficiency Level - 4
5 Competency for - Claims Clerk II
Proficiency Level - 5

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

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -2
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)
Modifies SOPs accordingly to reflect changes in our business practices and policies.
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Level 4 Behaviors
(Extensive Experience)
Optimizes the current SOP development and implementation processes.
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Level 5 Behaviors
(Mastery)
Leads cross-functional efforts to develop and implement SOPs across our organization.
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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)
Suggests solutions to issues that arise while executing the tasks.
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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 II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Clerk II
Proficiency Level - 4
5 Competency for - Claims Clerk II
Proficiency Level - 5

Summary of Claims Clerk II skills and competencies

There are 6 hard skills for Claims Clerk II, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Claims Clerk II, Data Entry, Payment Processing.
7 soft skills for Claims Clerk II, 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 II, 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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