Insurance Claims and Policy Processing Clerks
Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives.
Sample of reported job titles: Claim Processing Specialist, Claims Clerk, Claims Customer Service Representative (Claims CSR), Claims Processor, Claims Representative, Enrollment Representative, Insurance Analyst, Policy Service Coordinator, Policy Services Representative, Processing Clerk
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Tasks | Technology Skills | Tools Used | Knowledge | Skills | Abilities | Work Activities | Detailed Work Activities | Work Context | Job Zone | Credentials | Interests | Work Styles | Work Values | Related Occupations | Wages & Employment | Job Openings | Additional Information
- Prepare insurance claim forms or related documents, and review them for completeness.
- Calculate amount of claim.
- Post or attach information to claim file.
- Transmit claims for payment or further investigation.
- Contact insured or other involved persons to obtain missing information.
- Review insurance policy to determine coverage.
- Process and record new insurance policies and claims.
- Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
- Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
- Correspond with insured or agent to obtain information or to inform them of account status or changes.
- Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.
- Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.
- Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
- Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.
- Notify insurance agent and accounting department of policy cancellation.
- Pay small claims.
- Process, prepare, and submit business or government forms, such as submitting applications for coverage to insurance carriers.
- Collect initial premiums and issue receipts.
- Check computations of interest accrued, premiums due, and settlement surrender on loan values.
- Interview clients and take their calls to provide customer service and obtain information on claims.
- Obtain computer printout of policy cancellations, or retrieve cancellation cards from file.
- Compose business correspondence for supervisors, managers, and professionals.
- Apply insurance rating systems.
- Calculate premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards.
- Enter insurance- and claims-related information into database systems.
- Modify, update, or process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
- Organize or work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.
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- Accounting software — Account management software; Billing software
- Data base user interface and query software — Data entry software; Database software ; Microsoft Access ; Policy issuance system software (see all 9 examples)
- Document management software — InSystems Calligo Enterprise
- Electronic mail software — IBM Lotus Notes; MicroFocus GroupWise; Microsoft Outlook
- Financial analysis software — Insurance rating software
- Instant messaging software — GroupMe
- Internet browser software — Microsoft Internet Explorer; Web browser software
- Medical software — Healthcare common procedure coding system HCPCS ; Medical condition coding software ; Medical procedure coding software
- Office suite software — Microsoft Office
- Presentation software — Microsoft PowerPoint
- Spreadsheet software — Microsoft Excel
- Word processing software — Microsoft Word
Hot Technology — a technology requirement frequently included in employer job postings.
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- Customer and Personal Service — Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- Administrative — Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.
- English Language — Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
- Computers and Electronics — Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
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- Active Listening — Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
- Reading Comprehension — Understanding written sentences and paragraphs in work-related documents.
- Speaking — Talking to others to convey information effectively.
- Critical Thinking — Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
- Writing — Communicating effectively in writing as appropriate for the needs of the audience.
- Service Orientation — Actively looking for ways to help people.
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- Written Comprehension — The ability to read and understand information and ideas presented in writing.
- Oral Comprehension — The ability to listen to and understand information and ideas presented through spoken words and sentences.
- Oral Expression — The ability to communicate information and ideas in speaking so others will understand.
- Speech Recognition — The ability to identify and understand the speech of another person.
- Near Vision — The ability to see details at close range (within a few feet of the observer).
- Speech Clarity — The ability to speak clearly so others can understand you.
- Written Expression — The ability to communicate information and ideas in writing so others will understand.
- Information Ordering — The ability to arrange things or actions in a certain order or pattern according to a specific rule or set of rules (e.g., patterns of numbers, letters, words, pictures, mathematical operations).
- Deductive Reasoning — The ability to apply general rules to specific problems to produce answers that make sense.
- Problem Sensitivity — The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing that there is a problem.
- Inductive Reasoning — The ability to combine pieces of information to form general rules or conclusions (includes finding a relationship among seemingly unrelated events).
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- Working with Computers — Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
- Getting Information — Observing, receiving, and otherwise obtaining information from all relevant sources.
- Communicating with Supervisors, Peers, or Subordinates — Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
- Processing Information — Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
- Documenting/Recording Information — Entering, transcribing, recording, storing, or maintaining information in written or electronic/magnetic form.
- Evaluating Information to Determine Compliance with Standards — Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
- Communicating with People Outside the Organization — Communicating with people outside the organization, representing the organization to customers, the public, government, and other external sources. This information can be exchanged in person, in writing, or by telephone or e-mail.
- Establishing and Maintaining Interpersonal Relationships — Developing constructive and cooperative working relationships with others, and maintaining them over time.
- Making Decisions and Solving Problems — Analyzing information and evaluating results to choose the best solution and solve problems.
- Updating and Using Relevant Knowledge — Keeping up-to-date technically and applying new knowledge to your job.
- Performing Administrative Activities — Performing day-to-day administrative tasks such as maintaining information files and processing paperwork.
- Organizing, Planning, and Prioritizing Work — Developing specific goals and plans to prioritize, organize, and accomplish your work.
- Identifying Objects, Actions, and Events — Identifying information by categorizing, estimating, recognizing differences or similarities, and detecting changes in circumstances or events.
- Interpreting the Meaning of Information for Others — Translating or explaining what information means and how it can be used.
- Monitoring Processes, Materials, or Surroundings — Monitoring and reviewing information from materials, events, or the environment, to detect or assess problems.
- Analyzing Data or Information — Identifying the underlying principles, reasons, or facts of information by breaking down information or data into separate parts.
- Resolving Conflicts and Negotiating with Others — Handling complaints, settling disputes, and resolving grievances and conflicts, or otherwise negotiating with others.
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Detailed Work Activities
- Prepare documentation for contracts, transactions, or regulatory compliance.
- Check data for recording errors.
- Execute sales or other financial transactions.
- Calculate costs of goods or services.
- Compile data or documentation.
- Send information, materials or documentation.
- Review customer insurance information.
- Discuss account status or activity with customers or patrons.
- Maintain operational records.
- Enter information into databases or software programs.
- Explain regulations, policies, or procedures.
- Provide notifications to customers or patrons.
- Verify accuracy of financial or transactional data.
- Collect deposits, payments or fees.
- Answer telephones to direct calls or provide information.
- Interview employees, customers, or others to collect information.
- Obtain personal or financial information about customers or applicants.
- Prepare business correspondence.
- Provide information to coworkers.
- Code data or other information.
- Maintain financial or account records.
- Calculate financial data.
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- Electronic Mail — How often do you use electronic mail in this job?
- Spend Time Sitting — How much does this job require sitting?
- Telephone — How often do you have telephone conversations in this job?
- Importance of Being Exact or Accurate — How important is being very exact or highly accurate in performing this job?
- Importance of Repeating Same Tasks — How important is repeating the same physical activities (e.g., key entry) or mental activities (e.g., checking entries in a ledger) over and over, without stopping, to performing this job?
- Indoors, Environmentally Controlled — How often does this job require working indoors in environmentally controlled conditions?
- Contact With Others — How much does this job require the worker to be in contact with others (face-to-face, by telephone, or otherwise) in order to perform it?
- Work With Work Group or Team — How important is it to work with others in a group or team in this job?
- Letters and Memos — How often does the job require written letters and memos?
- Structured versus Unstructured Work — To what extent is this job structured for the worker, rather than allowing the worker to determine tasks, priorities, and goals?
- Face-to-Face Discussions — How often do you have to have face-to-face discussions with individuals or teams in this job?
- Time Pressure — How often does this job require the worker to meet strict deadlines?
- Frequency of Decision Making — How frequently is the worker required to make decisions that affect other people, the financial resources, and/or the image and reputation of the organization?
- Deal With External Customers — How important is it to work with external customers or the public in this job?
- Spend Time Making Repetitive Motions — How much does this job require making repetitive motions?
- Freedom to Make Decisions — How much decision making freedom, without supervision, does the job offer?
- Impact of Decisions on Co-workers or Company Results — What results do your decisions usually have on other people or the image or reputation or financial resources of your employer?
- Degree of Automation — How automated is the job?
- Deal With Unpleasant or Angry People — How frequently does the worker have to deal with unpleasant, angry, or discourteous individuals as part of the job requirements?
- Coordinate or Lead Others — How important is it to coordinate or lead others in accomplishing work activities in this job?
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|Title||Job Zone Two: Some Preparation Needed|
|Education||These occupations usually require a high school diploma.|
|Related Experience||Some previous work-related skill, knowledge, or experience is usually needed. For example, a teller would benefit from experience working directly with the public.|
|Job Training||Employees in these occupations need anywhere from a few months to one year of working with experienced employees. A recognized apprenticeship program may be associated with these occupations.|
|Job Zone Examples||These occupations often involve using your knowledge and skills to help others. Examples include orderlies, counter and rental clerks, customer service representatives, security guards, upholsterers, and tellers.|
|SVP Range||(4.0 to < 6.0)|
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Interest code: CES Want to discover your interests? Take the O*NET Interest Profiler at My Next Move.
- Conventional — Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.
- Enterprising — Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.
- Social — Social occupations frequently involve working with, communicating with, and teaching people. These occupations often involve helping or providing service to others.
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- Attention to Detail — Job requires being careful about detail and thorough in completing work tasks.
- Integrity — Job requires being honest and ethical.
- Dependability — Job requires being reliable, responsible, and dependable, and fulfilling obligations.
- Cooperation — Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
- Self-Control — Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.
- Independence — Job requires developing one’s own ways of doing things, guiding oneself with little or no supervision, and depending on oneself to get things done.
- Initiative — Job requires a willingness to take on responsibilities and challenges.
- Stress Tolerance — Job requires accepting criticism and dealing calmly and effectively with high-stress situations.
- Concern for Others — Job requires being sensitive to others’ needs and feelings and being understanding and helpful on the job.
- Achievement/Effort — Job requires establishing and maintaining personally challenging achievement goals and exerting effort toward mastering tasks.
- Adaptability/Flexibility — Job requires being open to change (positive or negative) and to considerable variety in the workplace.
- Persistence — Job requires persistence in the face of obstacles.
- Analytical Thinking — Job requires analyzing information and using logic to address work-related issues and problems.
- Social Orientation — Job requires preferring to work with others rather than alone, and being personally connected with others on the job.
- Leadership — Job requires a willingness to lead, take charge, and offer opinions and direction.
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- Relationships — Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment. Corresponding needs are Co-workers, Moral Values and Social Service.
- Support — Occupations that satisfy this work value offer supportive management that stands behind employees. Corresponding needs are Company Policies, Supervision: Human Relations and Supervision: Technical.
- Independence — Occupations that satisfy this work value allow employees to work on their own and make decisions. Corresponding needs are Creativity, Responsibility and Autonomy.
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Wages & Employment Trends
|Median wages (2020)||$20.22 hourly, $42,050 annual|
|Employment (2020)||277,900 employees|
|Projected growth (2020-2030)||Slower than average (1% to 5%)|
|Projected job openings (2020-2030)||26,700|
|Top industries (2020)||
Finance and Insurance
Source: Bureau of Labor Statistics 2020 wage data and 2020-2030 employment projections . “Projected growth” represents the estimated change in total employment over the projections period (2020-2030). “Projected job openings” represent openings due to growth and replacement.
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Job Openings on the Web
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Sources of Additional Information
Disclaimer: Sources are listed to provide additional information on related jobs, specialties, and/or industries. Links to non-DOL Internet sites are provided for your convenience and do not constitute an endorsement.
- American Bankers Association
- International Association of Insurance Professionals
- Mortgage Bankers Association
- Occupational Outlook Handbook: Financial clerks
- The National Alliance for Insurance Education and Research
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