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%
$47,169
TOTAL 50%
$48,444
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)
Names the commonly used tools and techniques for insurance planning and risk management.
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Level 2 Behaviors
(Light Experience)
Reports any discrepancies encountered in reviewing policy records and documentation.
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Level 3 Behaviors
(Moderate Experience)
Works with insurance agents and team members to update and process insurance policies.
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Level 4 Behaviors
(Extensive Experience)
Recommends alternative insurance claims processing methods to minimize operational costs.
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Level 5 Behaviors
(Mastery)
Stays abreast of the changes in insurance industry laws to ensure our product and service adherence.
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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)
Explains the application of insurance regulatory laws to avoid civil penalties and license suspension.
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Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
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Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
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Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
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Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
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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)
Lists commonly used tools and applications in conducting effective data entry.
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Level 2 Behaviors
(Light Experience)
Reports data entry-related areas to meet and exceed performance expectations.
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Level 3 Behaviors
(Moderate Experience)
Utilizes data resources in collecting and reviewing data to correct information errors and incompatibilities.
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Level 4 Behaviors
(Extensive Experience)
Organizes data submitted for entry to prevent data losses and ensure confidentiality.
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Level 5 Behaviors
(Mastery)
Leads the overall automation and optimization of data entry to eliminate manual processing.
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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)
Compiles the relevant information to support payment processing.
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Level 2 Behaviors
(Light Experience)
Applies knowledge of the process of card payment processing.
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Level 3 Behaviors
(Moderate Experience)
Investigates the relevant claims to complete payment processing accurately.
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Level 4 Behaviors
(Extensive Experience)
Coordinates the relevant payment processing tasks to help resolve issues.
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Level 5 Behaviors
(Mastery)
Champions the development and execution of standards and policies to ensure secure 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)
Cites examples of SOP practices in our business operations.
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Level 2 Behaviors
(Light Experience)
Assists in the preparation of internal standard operating procedures (SOP).
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Level 3 Behaviors
(Moderate Experience)
Ensures internal SOPs are in compliance with industry standards and regulations.
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Level 4 Behaviors
(Extensive Experience)
Develops and delivers training programs to ensure our SOPs are fully communicated and adhered to.
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Level 5 Behaviors
(Mastery)
Champions the adoption of SOP to foster efficiency and consistency.
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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)
Cites steps and tips to improve attention to detail in the workplace.
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Level 2 Behaviors
(Light Experience)
Keeps full attention when listening to understand the message.
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Level 3 Behaviors
(Moderate Experience)
Implements a variety of cross-checking approaches and mechanisms.
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Level 4 Behaviors
(Extensive Experience)
Creates and implements quality management processes for our business.
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Level 5 Behaviors
(Mastery)
Defines possible hurdles to projects and creates strategies to deal with them.
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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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