Skills & Competencies for Claims Examiner II

Claims Examiner II job profile

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JOB SUMMARY for Claims Examiner II

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

JOB RESPONSIBILITIES for Claims Examiner II

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 II SALARY RANGE

BASE 50%
$67,538
TOTAL 50%
$70,141
Job Level
P02
Job Code
FA06000072
Education/Degree
Bachelor's Degree
Reports To
Supervisor or Manager

Claims Examiner 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 Examiner II 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 II

1 Industry Competency – Insurance Industry
Proficiency Level -2
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)
Identifies the key legislation and regulations governing insurance contracts.
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Level 2 Behaviors
(Light Experience)
Records and maintains insurance policy and claims information in a database system.
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Level 3 Behaviors
(Moderate Experience)
Verifies received insurance coverage and damage reports to ensure accurate processing of claims.
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Level 4 Behaviors
(Extensive Experience)
Provides technical guidance to staff on claim investigation to ensure accurate insurance claims processing.
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Level 5 Behaviors
(Mastery)
Pursues creative initiatives that may differentiate our business and give us a competitive advantage.
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2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -2
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 II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner II
Proficiency Level - 4
5 Competency for - Claims Examiner II
Proficiency Level - 5

9 soft skills or competencies (core competencies) for Claims Examiner II

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)
Generates innovative plans for curating and managing gathered information from different sources.
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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)
Lists the typical processes of SOP development.
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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 II - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner II
Proficiency Level - 4
5 Competency for - Claims Examiner II
Proficiency Level - 5

Summary of Claims Examiner II skills and competencies

There are 10 hard skills for Claims Examiner II, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
0 general skills for Claims Examiner II.
9 soft skills for Claims Examiner II, Gathering Information, Standard Operating Procedures (SOP), Attention to Detail, etc.
While the list totals 19 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 II, 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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