Skills & Competencies for Claims Examiner I

Claims Examiner I job profile

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JOB SUMMARY for Claims Examiner I

Reviews, evaluates, and processes insurance claims and makes recommendations for resolution.

JOB RESPONSIBILITIES for Claims Examiner I

Examines and authorizes insurance claims investigated by insurance adjusters. Studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Determines settlement according to organization practices and procedures.

Claims Examiner I SALARY RANGE

BASE 50%
$53,499
TOTAL 50%
$55,027
Job Level
P01
Job Code
FA06000071
Education/Degree
Bachelor's Degree
Reports To
Supervisor or Manager

Claims Examiner 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 Examiner I skill and competencie below to view definitions.
INDUSTRY COMPETENCIES CORE COMPETENCIES
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10 hard skills or competencies (industry competencies) for Claims Examiner 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 current systems and scope of services provided by insurance organizations.
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Level 2 Behaviors
(Light Experience)
Follows industry best practices when preparing reports that detail risk assessment findings in insurance claims.
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Level 3 Behaviors
(Moderate Experience)
Identifies cost-effective solutions to address regulatory compliance challenges in insurance services.
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Level 4 Behaviors
(Extensive Experience)
Facilitates discussions with agents and underwriters on evolving exposures and risk management practices.
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Level 5 Behaviors
(Mastery)
Designs and executes innovative strategies and techniques to optimize the claims-handling process.
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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 Examiner I - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner I
Proficiency Level - 4
5 Competency for - Claims Examiner I
Proficiency Level - 5

8 soft skills or competencies (core competencies) for Claims Examiner I

1 Core Competencies – Gathering Information
Proficiency Level -2
Skill definition-Accumulating necessary information from various resources to clarify the situation or make an informed business decision.
Level 1 Behaviors
(General Familiarity)
Describes the importance of gathering relevant information in making informed business decisions.
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Level 2 Behaviors
(Light Experience)
Checks multiple sources to get complete and accurate information.
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Level 3 Behaviors
(Moderate Experience)
Asks questions and gathers the necessary information to make informed business decisions.
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Level 4 Behaviors
(Extensive Experience)
Monitors the overall process of records retention programs.
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Level 5 Behaviors
(Mastery)
Creates confidentiality agreements to ensure accurate submission of information from employees.
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2 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)
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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3 Claims Examiner I - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner I
Proficiency Level - 4
5 Competency for - Claims Examiner I
Proficiency Level - 5

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.

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