Skills & Competencies for Insurance Claim Service Representative III
Insurance Claim Service Representative III job profile
Book a Demo and Receive a Sample Job ProfileJOB SUMMARY for Insurance Claim Service Representative III
Processes, adjusts, and closes claims of moderate complexity in a contact center setting.
JOB RESPONSIBILITIES for Insurance Claim Service Representative III
Prepares initial claim reports, records statements from involved parties, and maintains First Notice of Loss (FNOL) information. Negotiates settlements within approved limits. Does not handle claims requiring outside field adjustment and refers complex claims to designated experts. May handle claims for bodily injury and third-party loss.
Insurance Claim Service Representative III SALARY RANGE
BASE 50%
$55,017
TOTAL 50%
$57,642
Job Level
A03
Job Code
FA06000981
Education/Degree
High School Diploma or Technical Certificate
Reports To
Supervisor or Manager
Insurance Claim Service Representative III Skills and Competencies List
8 hard skills or competencies (industry competencies) for Insurance Claim Service Representative III
1
Industry Competency –
Insurance Industry
Proficiency Level -2
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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2
Industry Competency –
Insurance Legal and Regulatory Environment
Proficiency Level -2
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
Insurance Claim Service Representative III
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Insurance Claim Service Representative III
Proficiency Level - 4
5
Competency for -
Insurance Claim Service Representative III
Proficiency Level - 5
2 general skills or competencies (Job family competencies) for Insurance Claim Service Representative III
1
Job Family Competencies –
Customer Relations
Proficiency Level -2
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 –
Customer Support
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Lists customer service tools used to track customer interactions and improve service delivery.
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Level 2 Behaviors
(Light Experience)
Supports the planning and execution of customer service tactics to improve service quality.
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Level 3 Behaviors
(Moderate Experience)
Uses metrics in analyzing areas of opportunities for customer service.
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Level 4 Behaviors
(Extensive Experience)
Trains and guides teams on effective techniques in customer service to retain customers and increase value.
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Level 5 Behaviors
(Mastery)
Leads customer support operations to monitor and determine growth opportunities for customer satisfaction.
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3
Insurance Claim Service Representative III
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Insurance Claim Service Representative III
Proficiency Level - 4
5
Competency for -
Insurance Claim Service Representative III
Proficiency Level - 5
9 soft skills or competencies (core competencies) for Insurance Claim Service Representative III
1
Core Competencies –
Standard Operating Procedures (SOP)
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Lists the typical processes of SOP development.
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Level 2 Behaviors
(Light Experience)
Supports the analysis of our business and operations processes for SOP design and development.
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Level 3 Behaviors
(Moderate Experience)
Researches new tools and techniques for SOP daily management.
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Level 4 Behaviors
(Extensive Experience)
Resolves complex issues arising from SOP practices; develops preventative solutions accordingly.
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Level 5 Behaviors
(Mastery)
Monitors industry for SOP trends and best practices; makes recommendations about those that benefit our business.
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2
Core Competencies –
Attention to Detail
Proficiency Level -2
Level 1 Behaviors
(General Familiarity)
Lists the traits of an employee showing great attention to detail.
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Level 2 Behaviors
(Light Experience)
Utilizes specific approaches and tools for checking and cross-checking outputs.
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Level 3 Behaviors
(Moderate Experience)
Uses tools to organize and monitor work progress.
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Level 4 Behaviors
(Extensive Experience)
Manages training to improve staffs' concentration and attention to detail.
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Level 5 Behaviors
(Mastery)
Learns from previous works' strengths and weaknesses to guide new projects.
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3
Insurance Claim Service Representative III
- Skill and Competency
Proficiency Level - 3
4
Skill and Competency -
Insurance Claim Service Representative III
Proficiency Level - 4
5
Competency for -
Insurance Claim Service Representative III
Proficiency Level - 5
Summary of Insurance Claim Service Representative III skills and competencies
There are 8 hard skills for Insurance Claim Service Representative III, Insurance Industry, Insurance Legal and Regulatory Environment, Insurance Products, etc.
2 general skills for Insurance Claim Service Representative III, Customer Relations, Customer Support.
9 soft skills for Insurance Claim Service Representative III, Standard Operating Procedures (SOP), Attention to Detail, Time Management, etc.
While the list totals 19 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 Insurance Claim Service Representative III, 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 Insurance Claim Service Representative III, Customer Relations, Customer Support.
9 soft skills for Insurance Claim Service Representative III, Standard Operating Procedures (SOP), Attention to Detail, Time Management, etc.
While the list totals 19 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 Insurance Claim Service Representative III, 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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