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)
Defines the key terminologies and components of an insurance policy.
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Level 2 Behaviors
(Light Experience)
Enters new information about insurance premiums and payments to update insurance policy records.
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Level 3 Behaviors
(Moderate Experience)
Examines insurance applications and letters from clients to determine necessary policy changes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates existing claims handling process to identify fraud and opportunities for optimization of outcomes.
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Level 5 Behaviors
(Mastery)
Champions the adoption of AI and automation technologies to streamline insurance operations.
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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)
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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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)
Cites examples of methods used to collect and compile information.
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Level 2 Behaviors
(Light Experience)
Applies techniques and tools to gather, organize, and archive pertinent information.
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Level 3 Behaviors
(Moderate Experience)
Analyzes employees' feedback to determine necessary changes to be implemented within our business.
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Level 4 Behaviors
(Extensive Experience)
Implements strategies to streamline the data collection process.
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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)
Cites examples of SOP practices in our business operations.
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Level 2 Behaviors
(Light Experience)
Assists in the preparation of internal standard operating procedures (SOP).
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Level 3 Behaviors
(Moderate Experience)
Ensures internal SOPs are in compliance with industry standards and regulations.
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Level 4 Behaviors
(Extensive Experience)
Develops and delivers training programs to ensure our SOPs are fully communicated and adhered to.
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Level 5 Behaviors
(Mastery)
Champions the adoption of SOP to foster efficiency and consistency.
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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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