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%
$53,368
TOTAL 50%
$54,890
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)
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 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)
Names commonly used tools and techniques for data collection.
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Level 2 Behaviors
(Light Experience)
Obtains needed information by asking skillful and persistent questions.
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Level 3 Behaviors
(Moderate Experience)
Utilizes various tools and technologies to validate information acquired from different sources.
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Level 4 Behaviors
(Extensive Experience)
Synthesizes information from various sources to enable strategic decision-making by our leadership.
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Level 5 Behaviors
(Mastery)
Takes steps to ensure that the intellectual property rights of others are not violated.
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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)
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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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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