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)
Names the commonly used tools and techniques for insurance planning and risk management.
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Level 2 Behaviors
(Light Experience)
Reports any discrepancies encountered in reviewing policy records and documentation.
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Level 3 Behaviors
(Moderate Experience)
Works with insurance agents and team members to update and process insurance policies.
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Level 4 Behaviors
(Extensive Experience)
Recommends alternative insurance claims processing methods to minimize operational costs.
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Level 5 Behaviors
(Mastery)
Stays abreast of the changes in insurance industry laws to ensure our product and service adherence.
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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 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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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)
Explains the importance of customer relations in delivering good customer service.
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Level 2 Behaviors
(Light Experience)
Reports customer escalations to identify and mitigate negative impacts on customer relations.
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Level 3 Behaviors
(Moderate Experience)
Helps in integrating CRM applications to deliver seamless customer service.
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Level 4 Behaviors
(Extensive Experience)
Monitors performance indicators of customer relationship management to support business growth.
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Level 5 Behaviors
(Mastery)
Develops an organizational framework to efficiently manage all relations throughout our customer base.
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Skill definition-Completing transfer of funds from the transaction to the merchant's account.
Level 1 Behaviors
(General Familiarity)
Discusses the best practices in payment processing.
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Level 2 Behaviors
(Light Experience)
Compiles all the invoices and enters them into the system for accurate payment processing.
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Level 3 Behaviors
(Moderate Experience)
Investigates the relevant claims to complete payment processing accurately.
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Level 4 Behaviors
(Extensive Experience)
Drives the entire supporting process that provides accurate payment processing.
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Level 5 Behaviors
(Mastery)
Designs a highly scalable and standard functional architecture for payment processing.
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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)
Describes the purposes and benefits of Standard Operating Procedures (SOP).
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Level 2 Behaviors
(Light Experience)
Compiles and maintains SOPs under our current policies and directions.
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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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Skill definition-Executing and completing a task with a high level of accuracy.
Level 1 Behaviors
(General Familiarity)
Explains why attention to detail plays an important role in own function or unit.
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Level 2 Behaviors
(Light Experience)
Performs assigned responsibilities according to standard procedures and standards.
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Level 3 Behaviors
(Moderate Experience)
Implements a variety of cross-checking approaches and mechanisms.
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Level 4 Behaviors
(Extensive Experience)
Demonstrates expertise in quality assurance tools, techniques, and standards.
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Level 5 Behaviors
(Mastery)
Designs techniques for measuring the cost and impact of errors.
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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.