Skills & Competencies for Claims Processing Clerk I - Healthcare

Claims Processing Clerk I - Healthcare job profile

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JOB SUMMARY for Claims Processing Clerk I - Healthcare

Receives and inputs new healthcare claims, processes payments, researches billing issues, and responds to email and telephone inquiries.

JOB RESPONSIBILITIES for Claims Processing Clerk I - Healthcare

Evaluates claims and administers payment, denies, or returns claims according to policy provisions and organizational guidelines. Produces routine and ad hoc reports.

Claims Processing Clerk I - Healthcare SALARY RANGE

BASE 50%
$40,535
TOTAL 50%
$41,276
Job Level
A01
Job Code
HC07000518
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor

Claims Processing Clerk I - Healthcare 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 Processing Clerk I - Healthcare skill and competencie below to view definitions.
INDUSTRY COMPETENCIES JOB FAMILY COMPETENCIES CORE COMPETENCIES
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8 hard skills or competencies (industry competencies) for Claims Processing Clerk I - Healthcare

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)
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 -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 Processing Clerk I - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Clerk I - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Clerk I - Healthcare
Proficiency Level - 5

2 general skills or competencies (Job family competencies) for Claims Processing Clerk I - Healthcare

1 Job Family Competencies – Customer Relations
Proficiency Level -1
Skill definition-Creating mutually beneficial relationships with customers to improve their overall experience.
Level 1 Behaviors
(General Familiarity)
Lists the pros and cons of using customer relationships management systems.
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Level 2 Behaviors
(Light Experience)
Supports CRM systems and applications to interact with customers.
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Level 3 Behaviors
(Moderate Experience)
Works closely with customers to use their insights in building strong customer relationships.
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Level 4 Behaviors
(Extensive Experience)
Trains staff on best practices in relationship management to establish customer connections.
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Level 5 Behaviors
(Mastery)
Leads our organization in promoting good relations with customers to optimize overall customer experience.
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2 Job Family Competencies – Payment Processing
Proficiency Level -1
Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Lists major activities involved in payment processing.
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Level 2 Behaviors
(Light Experience)
Records the periodic processing of payables to handle payment processing.
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Level 3 Behaviors
(Moderate Experience)
Works with the relevant staff to minimize administrative burdens relating to payment processing.
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Level 4 Behaviors
(Extensive Experience)
Oversees the day-to-day operations related to payment processing in support of business activities.
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Level 5 Behaviors
(Mastery)
Leads the provision of invoice processing instruction and training for posting invoices for payment.
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3 Claims Processing Clerk I - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Clerk I - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Clerk I - Healthcare
Proficiency Level - 5

6 soft skills or competencies (core competencies) for Claims Processing Clerk I - Healthcare

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -1
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)
Gathers information on workflows and business controlling points.
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Level 3 Behaviors
(Moderate Experience)
Initiates SOP revisions to support continuous improvement of processes.
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Level 4 Behaviors
(Extensive Experience)
Evaluates the benefits and drawbacks of a specific SOP; oversees the corresponding enhancements.
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Level 5 Behaviors
(Mastery)
Establishes formal policies and procedures to guide the our SOP practices.
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2 Core Competencies – Attention to Detail
Proficiency Level -2
Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Identifies the procedures for making sure that results are mistake-free.
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Level 2 Behaviors
(Light Experience)
Records all appointments on the calendar to easily track daily activities.
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Level 3 Behaviors
(Moderate Experience)
Reviews and analyzes the accuracy of data and details.
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Level 4 Behaviors
(Extensive Experience)
Designs systems to help the team organize and track details and project progress.
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Level 5 Behaviors
(Mastery)
Develops best practices for identifying and correcting errors, oversights, and omissions.
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3 Claims Processing Clerk I - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Clerk I - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Clerk I - Healthcare
Proficiency Level - 5

Summary of Claims Processing Clerk I - Healthcare skills and competencies

There are 8 hard skills for Claims Processing Clerk I - Healthcare, Insurance Industry, Insurance Legal and Regulatory Environment, Health Insurance, etc.
2 general skills for Claims Processing Clerk I - Healthcare, Customer Relations, Payment Processing.
6 soft skills for Claims Processing Clerk I - Healthcare, Standard Operating Procedures (SOP), Attention to Detail, Time Management, etc.
While the list totals 16 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 Processing Clerk I - Healthcare, he or she needs to be proficient in Standard Operating Procedures (SOP), be proficient in Attention to Detail, and be proficient in Time Management.

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