8 hard skills or competencies (industry competencies) for Claims Processing Clerk I - Healthcare
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)
Describes the current systems and scope of services provided by insurance organizations.
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Level 2 Behaviors
(Light Experience)
Follows industry best practices when preparing reports that detail risk assessment findings in insurance claims.
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Level 3 Behaviors
(Moderate Experience)
Identifies cost-effective solutions to address regulatory compliance challenges in insurance services.
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Level 4 Behaviors
(Extensive Experience)
Facilitates discussions with agents and underwriters on evolving exposures and risk management practices.
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Level 5 Behaviors
(Mastery)
Designs and executes innovative strategies and techniques to optimize the claims-handling process.
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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 basic structure of insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Complies with insurance legal and regulatory principles to safeguard the rights and interests of the insured.
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Level 3 Behaviors
(Moderate Experience)
Analyzes existing legal and regulatory standards to address errors affecting insurance policies.
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Level 4 Behaviors
(Extensive Experience)
Improves legal procedures for licensing intermediaries or producers to prevent penalties.
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Level 5 Behaviors
(Mastery)
Designs compliance strategies and programs to prevent violations of statutes, regulations, and policies.
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2 general skills or competencies (Job family competencies) for Claims Processing Clerk I - Healthcare
Skill definition-Creating mutually beneficial relationships with customers to improve their overall experience.
Level 1 Behaviors
(General Familiarity)
Documents the best practices and techniques used in creating customer relations.
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Level 2 Behaviors
(Light Experience)
Collects customer feedback to measure customer satisfaction and ensure customer relations.
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Level 3 Behaviors
(Moderate Experience)
Ensures accurate and prompt responses to customer complaints to maintain optimal customer relations.
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Level 4 Behaviors
(Extensive Experience)
Determines key opportunities to build and maintain customer relationships and drive business results.
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Level 5 Behaviors
(Mastery)
Champions the adoption of advanced systems and tools to improve the development of customer relations.
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Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Discusses various payment processing rules and regulations.
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Level 2 Behaviors
(Light Experience)
Enters relevant information into the system for accurate payment processing.
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Level 3 Behaviors
(Moderate Experience)
Performs the electronic payment processing of transactions for our business.
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Level 4 Behaviors
(Extensive Experience)
Ensures the accurate recording of relevant data for all payment processing transactions.
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Level 5 Behaviors
(Mastery)
Develops an organizational structure to manage the processing of invoices efficiently.
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6 soft skills or competencies (core competencies) for Claims Processing Clerk I - Healthcare
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)
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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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)
Processes limited amounts of detailed information with reasonable accuracy.
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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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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.