Claims Processor Job Description

What is a Claims Processor?

Claims processors work in the insurance industry and handle insurance claims. They review claims submissions, obtain and verify information, correspond with insurance agents and beneficiaries, and process claim payments. They communicate with insurance agents and beneficiaries and prepare claims forms and related documentation. They are responsible for reviewing claims submissions and verifying the information contained therein.

Claims processors record and maintain insurance policy and claim information in database systems and determine policy coverage while calculating claim amounts. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. Claims processors need at least two years of experience as a claims processor or similar and working knowledge of the insurance industry and relevant federal and state regulations.

Claims Processor Job Description Template

Job Overview

Responsibilities for Claims Processor

  • Effectively manage a portfolio of various type of claims.
  • Update and maintain claim files to ensure complete records.
  • Respond timely to internal and external inquiries for information relative to claims.
  • Review, prepare, create, and/or send letters, reports, and forms.
  • Communicate claim action/processing with claimant, client and appropriate medical contact.
  • Identify notification issues, coordinates resolution and takes corrective actions as needed.
  • Engage and address any customer inquiries related to lien/bond claim notices sent to property owners, general contractors, and subcontractors.
  • Collaborate with the claim handlers in preparing the claim notices.
  • Maintain action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. escalates issues as needed.
  • Provide support and assistance in updating reinsurance systems and information.

Qualifications for Claims Processor

  • Bachelor's Degree in business or computer science.
  • Exhibit strong critical thinking and problem solving skills.
  • Demonstrated careful attention to detail.

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Employers: How to Write Great Job Descriptions

  • Be sure to mention requisite years of experience and educational requirements
  • Tell job seekers what's unique about your company and job
  • Ideal length is a few paragraphs or about 200 words
  • Make sure to use appropriate paragraph breaks and bullet points so it's easy on the eyes
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