Claims Processor job description template
If you are hiring for this role, start here. This free template is our detailed definition of the position, with everything you need to find and hire the right person. Copy it, add your own requirements, and post it.
What is a Claims Processor?
Claims Processors are responsible for handling, reviewing, and processing insurance claims from clients.
They determine if submitted claims are accurate and eligible for financial compensation and coverage.
Claims Processors communicate with clients to collect and verify their information, determine the validity of claims, calculate amounts of compensation, coverage limits, and exclusions, and correct claims mistakes and discrepancies.
They also provide guidance and assistance to clients, address their complaints and inquiries, and schedule appointments.
The top Claims Processor skills.
Five things separate a strong hire from a résumé that reads well. Use these as your scorecard criteria.
The job description, ready to post.
Copy it as written, or edit it until it sounds like your company. Both work.
Our company is looking for an organized and detail-oriented Claims Processor. In this position, you will be responsible for processing, reviewing, and verifying insurance claims and applications. Your job will be to determine if they are correct, accurate, and eligible for compensation and coverage. You will communicate with clients to collect their information and prepare and maintain claim submissions and records in paper and digital forms.
Additionally, you will perform administrative duties, such as answering phones and scheduling appointments and provide assistance and guidance to clients regarding claims forms. You will also discover and resolve mistakes and discrepancies in documentation and process payments to clients.
As a Claims Processor, you should have outstanding verbal and written communication, problem-solving, attention to detail, organization, computer, and mathematical skills.
Duties and responsibilities
- Process and review insurance claims and applications to determine if they are eligible
- Communicate with clients to gather and verify pertinent information about their claims
- Assess damages and calculate amounts of compensation, coverage limits, exclusions, etc
- Determine the validity of claims based on policy provisions and state and federal laws
- Record, prepare, and maintain claims forms, reports, submissions, and other documentation in database systems and paper forms
- Ensure the necessary insurance paperwork is complete and accurate
- Provide guidance and assistance to clients by answering questions, helping them file claims, etc
- Perform administrative tasks, such as answering phone calls and emails and scheduling appointments
- Identify and resolve mistakes and discrepancies in claims, such as incorrect dates, names, amounts, etc
- Apply insurance rating systems to clients’ insurance policies and process payments
- Notify insurance agents or other responsible parties of policy cancellations and other changes
Requirements
- Bachelor’s degree in economics, finance, accounting, business, or a related field
- Experience as a Claims Processor or a similar position in the insurance industry
- Solid knowledge of the insurance industry, practices, laws, and regulations
- Strong computer literacy (MS Office)
- Great mathematical and numerical skills
- Excellent administrative and organizational skills
- Outstanding verbal and written communication
- Effective problem-solving
- Keen attention to detail
Take the template with you
Copy it straight into your job board or ATS, or have it emailed to you with the interview questions for this role.
What education this role needs.
A Bachelor’s degree in finance, economics, business, accounting, or a related field is a typical requirement for Claims Processors.
A small number of employers would hire candidates with a high school diploma or GED if they possessed a relevant set of skills and basic knowledge and then provide on-the-job training.
On certain occasions, candidates with previous working experience would also receive on-the-job training to learn about the company’s policies, computer systems, and ways to handle clients.
Sample interview questions for a Claims Processor.
Once you have gathered the applications, work through these in order. Twelve questions across four areas, enough to tell your shortlist apart.
- What adjectives describe you the best?
- What attracted you to work in the insurance field?
- Is there any bad habit that you would like to change in the future?
- Could you tell us about your first employment as a Claims Processor?
- What makes you more suitable and qualified for this position than other applicants?
- Do you have any questions about the company or job so far?
- How do you remain organized as a Claims Processor?
- How would you rate your multitasking skills?
- What do you find the most challenging part of being a Claims Processor?
- How familiar are you with state and federal laws and regulations regarding the insurance industry?
- What is your typical process of assessing and reviewing a claim?
- What would you do if you had a claim that you don’t know how to process?
How much to pay when hiring.
Annual pay by percentile. Where you land depends on the size of the cycle they will own, and the 25th percentile is usually where a first analyst hire sits.
Hourly equivalents run from $12 at the 10th percentile to $23 at the 90th.
Candidates may apply under a different name.
Post the title your industry uses and keep the rest of the description. These three roles overlap enough that the same posting usually reaches all of them.
Three titles, one description.
Search behavior varies by industry, so the same job is advertised under several names. If you are unsure which one your candidates search for, run two titles and see which fills.
Claims Specialist
Claims Specialists, also known as Claims Examiners or Claims Consultants, work in the insurance industry.
$40,455 medianClaims Adjuster
Claims Adjusters are professionals who evaluate insurance claims and survey damages to property, automobiles, homes, and personal injuries.
$51,618 medianFrequently asked questions.
What do Claims Processors do?
Claims Processors process, review, and verify insurance claims and determine if they are eligible for compensation and coverage.
They calculate amounts of compensation, collect information from clients, maintain claim forms and records, and provide assistance and guidance to clients.
In what type of insurance companies can Claims Processors work?
There are different insurance companies that provide employment for Claims Processors, such as:
- Health
- Home
- Care
- Travel
- Life
- Unemployment
- Disability, etc
Who do Claims Processors report to?
Claims Processors usually report to the Claims Manager.
What are the crucial skills for Claims Processors?
Claims Processors must have exceptional verbal and written communication, computer literacy, attention to detail, organization, problem-solving, and mathematical skills.
Other job description templates.
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Claims Adjuster
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