Skills & Competencies for Claims Examiner IV

Claims Examiner IV job profile

Book a Demo and Receive a Sample Job Profile

JOB SUMMARY for Claims Examiner IV

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

JOB RESPONSIBILITIES for Claims Examiner IV

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 IV SALARY RANGE

BASE 50%
$99,770
TOTAL 50%
$107,080
Job Level
P04
Job Code
FA06001043
Education/Degree
Bachelor's Degree
Reports To
Supervisor or Manager

Claims Examiner IV 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 IV skill and competencie below to view definitions.
INDUSTRY COMPETENCIES CORE COMPETENCIES
BOOK A DEMO

10 hard skills or competencies (industry competencies) for Claims Examiner IV

1 Industry Competency – Insurance Industry
Proficiency Level -3
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.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Reports any discrepancies encountered in reviewing policy records and documentation.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Works with insurance agents and team members to update and process insurance policies.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Recommends alternative insurance claims processing methods to minimize operational costs.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Stays abreast of the changes in insurance industry laws to ensure our product and service adherence.
See 4 More Skill Behaviors
2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -3
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.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
See 4 More Skill Behaviors
3 Claims Examiner IV - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner IV
Proficiency Level - 4
5 Competency for - Claims Examiner IV
Proficiency Level - 5

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

1 Core Competencies – Gathering Information
Proficiency Level -4
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.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Obtains needed information by asking skillful and persistent questions.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Utilizes various tools and technologies to validate information acquired from different sources.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Synthesizes information from various sources to enable strategic decision-making by our leadership.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Takes steps to ensure that the intellectual property rights of others are not violated.
See 4 More Skill Behaviors
2 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -3
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.
See 4 More Skill Behaviors
Level 2 Behaviors
(Light Experience)
Supports the analysis of our business and operations processes for SOP design and development.
See 4 More Skill Behaviors
Level 3 Behaviors
(Moderate Experience)
Researches new tools and techniques for SOP daily management.
See 4 More Skill Behaviors
Level 4 Behaviors
(Extensive Experience)
Resolves complex issues arising from SOP practices; develops preventative solutions accordingly.
See 4 More Skill Behaviors
Level 5 Behaviors
(Mastery)
Monitors industry for SOP trends and best practices; makes recommendations about those that benefit our business.
See 4 More Skill Behaviors
3 Claims Examiner IV - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Examiner IV
Proficiency Level - 4
5 Competency for - Claims Examiner IV
Proficiency Level - 5

Summary of Claims Examiner IV skills and competencies

There are 10 hard skills for Claims Examiner IV, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
0 general skills for Claims Examiner IV.
9 soft skills for Claims Examiner IV, 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 IV, he or she needs to be skilled in Gathering Information, be skilled in Standard Operating Procedures (SOP), and be skilled in Attention to Detail.

It's Easy to Get Started

Get the precision you need to assess, hire, and develop top talent with skills and competencies – see how with a personalized demo.