Skills & Competencies for Claims Processing Clerk III - Healthcare
Claims Processing Clerk III - Healthcare job profile
Book a Demo and Receive a Sample Job ProfileJOB SUMMARY for Claims Processing Clerk III - Healthcare
Receives and inputs new healthcare claims, processes payments, conducts billing research, and responds to telephone inquires.
JOB RESPONSIBILITIES for Claims Processing Clerk III - 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 III - Healthcare SALARY RANGE
BASE 50%
$51,680
TOTAL 50%
$53,005
Job Level
A03
Job Code
HC07000519
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor
Claims Processing Clerk III - Healthcare Skills and Competencies List
9 hard skills or competencies (industry competencies) for Claims Processing Clerk III - Healthcare
1
Industry Competency –
Insurance Industry
Proficiency Level -2
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)
Makes necessary adjustments to insurance policies to meet customer needs.
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Level 4 Behaviors
(Extensive Experience)
Handles complex insurance losses through negotiation of favorable claims settlements with insurance companies.
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Level 5 Behaviors
(Mastery)
Develops and establishes risk reduction best practices to prevent fraudulent claims transactions.
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2
Industry Competency –
Insurance Legal and Regulatory Environment
Proficiency Level -2
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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3
Claims Processing Clerk III - Healthcare
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Processing Clerk III - Healthcare
Proficiency Level - 4
5
Competency for -
Claims Processing Clerk III - Healthcare
Proficiency Level - 5
2 general skills or competencies (Job family competencies) for Claims Processing Clerk III - Healthcare
1
Job Family Competencies –
Customer Relations
Proficiency Level -2
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)
Handles customer issues and concerns effectively to maximize customer satisfaction and relations.
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Level 4 Behaviors
(Extensive Experience)
Facilitates strategic customer relationships to uncover and meet customer expectations.
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Level 5 Behaviors
(Mastery)
Creates best practices to balance customer needs with our interests to create positive relationships.
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2
Job Family Competencies –
Payment Processing
Proficiency Level -2
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)
Partners with the relevant departments to provide support matters related to payment processing.
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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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3
Claims Processing Clerk III - Healthcare
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Processing Clerk III - Healthcare
Proficiency Level - 4
5
Competency for -
Claims Processing Clerk III - Healthcare
Proficiency Level - 5
7 soft skills or competencies (core competencies) for Claims Processing Clerk III - Healthcare
1
Core Competencies –
Standard Operating Procedures (SOP)
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Describes the purposes and benefits of Standard Operating Procedures (SOP).
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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)
Implements the use of SOP throughout our business to drive efficiency.
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Level 4 Behaviors
(Extensive Experience)
Enhances the SOP management system to improve efficiency and user experience.
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Level 5 Behaviors
(Mastery)
Designs a Standard Operating Procedure (SOP) strategy to align with our business objectives.
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2
Core Competencies –
Attention to Detail
Proficiency Level -2
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)
Processes limited amounts of detailed information with reasonable accuracy.
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Level 3 Behaviors
(Moderate Experience)
Processes large quantities of detailed information with high levels of accuracy.
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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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3
Claims Processing Clerk III - Healthcare
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Claims Processing Clerk III - Healthcare
Proficiency Level - 4
5
Competency for -
Claims Processing Clerk III - Healthcare
Proficiency Level - 5
Summary of Claims Processing Clerk III - Healthcare skills and competencies
There are 9 hard skills for Claims Processing Clerk III - Healthcare, Insurance Industry, Insurance Legal and Regulatory Environment, Health Insurance, etc.
2 general skills for Claims Processing Clerk III - Healthcare, Customer Relations, Payment Processing.
7 soft skills for Claims Processing Clerk III - Healthcare, Standard Operating Procedures (SOP), Attention to Detail, Time Management, etc.
While the list totals 18 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 III - 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.
2 general skills for Claims Processing Clerk III - Healthcare, Customer Relations, Payment Processing.
7 soft skills for Claims Processing Clerk III - Healthcare, Standard Operating Procedures (SOP), Attention to Detail, Time Management, etc.
While the list totals 18 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 III - 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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