Claims Specialist Job Description

The Benefits of a Degree in Insurance Claims

When an individual files a claim with an insurance company, claims specialists get to work on financial resolution. Specialists process claims and negotiate settlements for insurance. Managing client accounts before, during and after a claim is filed is the primary responsibility of their specific duties.

A high school degree can help you get a job as a claims specialist. Employers prefer to hire people with a bachelor's degree in a related field. A degree may be considered in lieu of education and experience.

Some employers and state governments require claims specialists to be licensed. The requirements for obtaining a license vary from state to state. The Bureau of Labor Statistics 2012 data shows that the annual median salary for claims specialists is $59,960.

Job responsibilities, job location, years of experience and employment industry all affect salaries for claim specialists. Many claims specialist spend a lot of their time in an office environment looking at information and data. Some specialists travel to their clients to look at damage.

Insurance Claims Specialists: Career Opportunities and Qualification Criteria

An insurance claims specialist made a median hourly wage of over $29. The top 10% of claims specialists made around $18.00 per hour, while the lower 10% made around $44.20 per hour. The variety of duties and responsibilities can be a factor in the large variation in wages.

The field is expected to grow 3% between 2012 and 2022, which is slower than the national average. Slow growth in the insurance claims specialists in the automotive industry is expected. Health care fields are expected to have better opportunities than other industries because patients make more insurance claims.

An insurance claims specialist is responsible for investigating damage and injuries, researching reports, interviewing witnesses, preparing reports, processing payments and gathering evidence. They review insurance claims and decide appropriate payments. Insurance claims specialists are sometimes required to testify in court.

A high school degree or equivalent is required for many insurance claims specialist positions. Career experience can be considered relevant when working in positions such as insurance claims clerk, billing and coding worker, customer service representative or similar occupations. Some employers look for candidates with appropriate state licensure.

A bachelor's degree in an insurance, business or job related field is required for some advanced positions. Employers prefer candidates with relevant experience because there are no universal educational requirements. If you want to gain experience in the field, you should begin your career as an insurance claims clerk.

Candidates for Claims Assistance Positions

The claims assistance professionals are responsible for logging incoming claims, filing them, assisting in payments and billing and maintaining other claims processing procedures. They may be responsible for general administrative and clerical work around the office, as well as contacting insured individuals to obtain all of the information necessary to process claims. Financial services companies, insurance businesses and medical providers are some of the industries where claims assistance professionals work.

People with experience in clerical work are well suited for claims assistance positions. It is recommended that applicants have experience with basic computer programs such as the Microsoft Office Suite, which include programs like Microsoft Word and Microsoft excel. The program that is frequently used for clerical duties is the spreadsheet-based program, and experience with it is very valuable.

Candidates should be comfortable using new applications and software that is specific to claims processing. Strong typing skills are needed for data entry. Candidates for claims assistance positions should be comfortable working in a fast-paced environment where they may be asked to perform many different tasks throughout the day.

They must have strong organizational skills and an attention to detail. Since claims assistance professionals are often responsible for both the opening and final processing of claims, it is important that they pay close attention to their work and perform it in a careful and professional manner. They must have the ability to communicate clearly, as they may be asked to talk to customers about potential issues with their claims.

Analyzing Insurance Claims

You must analyze insurance claims to be a claim specialist. By doing this, you can help to prevent fraud. You are supposed to review the claims reports and court verdicts.

You need to give detailed inspections in order to organize and present claim review plans. You should have good communication and analytical skills if you want to become a claim specialist. You have to provide a high knowledge of insurance claim negotiations and settlement regulations.

You need to have a good understanding of the latest insurance policies. The claim specialist will help the clients to understand the benefits of their allowance. A claim specialist can testify in a court.

A Claims Specialist in the Company

A claims specialist needs to be organized in the general organizing, planning, communication, time management, scheduling, coordinating resources and meeting deadlines to support the staff in being well structured and run the company successfully. A claims specialist needs to learn to resolve workplace disputes using the principles of fairness, seeking mutual benefit and maintaining a good relationship at the workplace. A claims specialist is meant to work with all workers and management, without causing any problems or sidelining any worker, and at the same time, not delay their promotion from informal conversations where most decisions are often made.

A claims specialist should be able to empathise with his staff by learning to be a good listener and understand what their employees are going through, and by using imagination and accommodating them. A claims specialist needs to design ways that will drive the staff to carry out their work without wasting time by helping them understand develop their self-motivation skills that will help them take control of many different viewpoints of their life. A claims specialist needs to train his employees to see the missing element in any project and take the opportunity to do business out of it.

A claims specialist must understand that pleasing customers is a direct result of the success of the business and that every employee should follow in ensuring all the customers are treated as they should. A claims specialist should hire employees who are good at understanding an issue from all angles and who are good at using methodical approaches to benefit the company's productivity. A claims specialist should ensure that the teams understand the company's goods or services and can quickly take a client through them, in order to instill faith, trust and respect in the customers, which in turn creates a positive customer experience.

Health Claims Specialists

If you have an appreciation for detail, are good with paperwork, and want to work in an office, then becoming a health claims specialist is the perfect career path for you. Expansion opportunities will be welcome, as will you enjoying your work life. A health claims specialist uses a computer and the telephone a lot, and they often spend much of their day on the phone.

Their job is to gather and process information needed to prepare and submit documentation that is used to get reimbursement for healthcare services that have been provided to patients. The health claims specialist can update the patient's records to show a claim has been made and may need to update other logs and records to maintain a high level of overview of claims and billing amounts. There are often disputes about responsibility for payment between healthcare providers, insurance companies, and patients which must be resolved before reimbursement is provided.

Health claims specialists help resolve outstanding disputes by following up and resolving any queries. A high school degree is enough to get an entry-level role as a health claims specialist. If you want to get such a role, you should take relevant high school classes such as math, biology, and computer science.

The training may be provided by the employer and may cover topics such as medical terminology, insurance forms and procedures, medical and procedural coding, and how to use organizational IT systems and software. Health claims specialists don't need professional certification to find employment. Health claim specialists who get professional certification to show their skills are more attractive to potential employers.

A health claims specialist uses a computer to complete most of their work, but may use two or more monitors. Health claims specialists need to be able to navigate the computer software that is required to perform their roles. Health claims specialists spend a lot of time on the phone with patients, insurance companies, government agencies and healthcare professionals.

Graduate-Management Schemes in Insurance

You will be involved in managing a claim from the start to the settlement, making decisions on the extent and validity of a claim, and checking for any fraudulent activity. The graduate schemes are available with the larger insurance companies. There are opportunities for claims work in graduate-management training schemes.

Employers often ask for a 2:1 degree in any degree subject. You can go directly into claims work after training. Both graduates and those without a degree can find opportunities.

Junior clerical positions, such as administration assistant or technician, can be used to move up the company's hierarchy. There are opportunities to move up the management structure. In larger company structures, claims handlers can progress to manager and then claims director.