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%
$67,370
TOTAL 50%
$69,968
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)
Explains how reinsurance aids in meeting the long-term debts and financial obligations of a business.
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Level 2 Behaviors
(Light Experience)
Locates resources to acquire updates regarding market shifts and regulatory changes in insurance.
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Level 3 Behaviors
(Moderate Experience)
Prepares insurance plans based on client needs to minimize financial risk or losses during uncertain events.
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Level 4 Behaviors
(Extensive Experience)
Monitors industry changes to improve the strategic directions of insurance operations.
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Level 5 Behaviors
(Mastery)
Develops strategic methods for selling insurance policies to increase the profit of our organization.
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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)
Describes the importance of compliance programs in maintaining an insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Documents compliance complaints to track and escalate possible legal violations and ensure prompt resolution.
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Level 3 Behaviors
(Moderate Experience)
Executes market conduct exams to verify the adherence of insurance operations to laws and regulations.
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Level 4 Behaviors
(Extensive Experience)
Reviews root causes of regulatory deficiencies to create corrective action plans and ensure adherence.
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Level 5 Behaviors
(Mastery)
Develops an insurance regulatory framework to promote consumers' protection and achieve policy objectives.
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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)
Explains the use of surveys and interviews in gathering the necessary information.
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Level 2 Behaviors
(Light Experience)
Conducts basic research to identify current industry trends and best practices.
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Level 3 Behaviors
(Moderate Experience)
Participates in various company events to gain information about current business operations.
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Level 4 Behaviors
(Extensive Experience)
Provides training to others about new techniques and strategies for effective data collection.
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Level 5 Behaviors
(Mastery)
Designs a system for monitoring the effectiveness of data-gathering channels.
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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)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Documents the SOP drafts and outlines for final approval.
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Level 3 Behaviors
(Moderate Experience)
Implements the use of SOP throughout our business to drive efficiency.
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Level 4 Behaviors
(Extensive Experience)
Enhances the SOP management system to improve efficiency and user experience.
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Level 5 Behaviors
(Mastery)
Designs a Standard Operating Procedure (SOP) strategy to align with our business objectives.
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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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