10 hard skills or competencies (industry competencies) for Claims Examiner I
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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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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8 soft skills or competencies (core competencies) for Claims Examiner I
Skill definition-Accumulating necessary information from various resources to clarify the situation or make an informed business decision.
Level 1 Behaviors
(General Familiarity)
Lists the principles and procedures of gathering information.
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Level 2 Behaviors
(Light Experience)
Determines the source of information to verify its reliability.
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Level 3 Behaviors
(Moderate Experience)
Uses survey results to identify areas that need improvement within our business.
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Level 4 Behaviors
(Extensive Experience)
Recommends improvement of our business's records retention program.
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Level 5 Behaviors
(Mastery)
Establishes procedures for gathering information to anticipate future customer or business needs.
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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)
Gathers information on workflows and business controlling points.
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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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Summary of Claims Examiner I skills and competencies
There are 10 hard skills for Claims Examiner I, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
0 general skills for Claims Examiner I.
8 soft skills for Claims Examiner I, Gathering Information, Standard Operating Procedures (SOP), Attention to Detail, etc.
While the list totals 18 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 Examiner I, he or she needs to be proficient in Gathering Information, be proficient in Standard Operating Procedures (SOP), and be proficient in Attention to Detail.