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%
$51,812
TOTAL 50%
$53,139
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)
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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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)
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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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)
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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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)
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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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)
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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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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