Claims Specialist 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 Specialist?
Claims Specialists, also known as Claims Examiners or Claims Consultants, work in the insurance industry.
A Claims Specialist processes, reviews, and analyzes claims that people file against their insurance companies.
Their job is to establish and decide whether they should be paid out or not.
Additionally, Claims Specialists negotiate claims settlements and verify insurance coverage.
They also conduct site and damage inspections to gather more information and make the right decision.
In the end, Claims Specialists are responsible for resolving clients’ inquiries and updating them on claim statuses.
The top Claims Specialist 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.
We are looking for a highly analytical Claims Specialist to join our insurance company. Reviewing insurance policies and client claims will be your responsibility in order to decide whether or not a client should receive payment. Moreover, you will be responsible for a thorough investigation of insurance claims to ensure their accuracy and prevent fraud. You will also negotiate claims terms and conditions with insurance companies and prepare claims settlements.
You will be required to visit accident sites to assess the level of damage and ask questions to gather the necessary information. The perfect candidate for this position should have in-depth knowledge of the latest policies and guidelines in the insurance industry. Ultimately, the skills we are looking for are excellent communication, problem-solving, attention to detail, organization, and an analytical mind.
Duties and responsibilities
- Review insurance policies, medical records, and other documentation to establish coverage for claims
- Analyze and investigate insurance claims to discover or prevent fraud
- Prepare reports and statements by gathering and summarizing information
- Resolve claims by approving or declining documentation
- Establish compensation settlements
- Conduct detailed site and damage inspection
- Negotiate claim terms and conditions with insurance companies
- Calculate commissions and other fees owed by policyholders
- Maintain quality customer service by providing information to clients about coverage options, payments plans, etc
- Handle and resolve clients’ inquiries and concerns
- Ensure compliance with the companies policies and guidelines and state and federal insurance regulations
- Collaborate with attorneys to prepare claims settlements and receive legal support
Requirements
- High school diploma or a GED
- A Bachelor’s degree in finance, business, accounting, or a similar discipline
- Previous working experience in similar positions
- Strong knowledge of current insurance state and federal laws, policies, and regulations
- Outstanding communication and negotiation skills
- Excellent organization
- Strong analytical mind
- Superb 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.
The majority of companies and employers look for candidates with a Bachelor’s degree in business, accounting, finance, or a similar discipline.
Other employers consider a high school diploma or a GED is enough.
A huge advantage for candidates in the insurance industry is previous working experience.
Those who are familiar with the latest insurance policies and regulations and handling complex paperwork and situations are more likely to expand their hiring opportunities.
Sample interview questions for a Claims Specialist.
Once you have gathered the applications, work through these in order. Twelve questions across four areas, enough to tell your shortlist apart.
- Tell us a little bit about yourself.
- What are your three most prominent traits?
- Do you have a favorite sport?
- What do you consider the most important skill for a Claims Specialist?
- What industries have you worked in so far?
- Could you tell us more about your major in college?
- How well do you handle stressful situations?
- Have you ever made a mistake while investigating a claim? What happened then?
- How do you stay organized when having a lot to do on a particular day?
- In what instances do you deny a claim?
- How do you determine if a claim is convenient for compensation?
- How familiar are you with insurance software and complex insurance forms?
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 $25 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 Adjuster
Claims Adjusters are professionals who evaluate insurance claims and survey damages to property, automobiles, homes, and personal injuries.
$51,618 medianInsurance Underwriter
Frequently asked questions.
Where do Claims Specialists work?
Claims Specialists can work for auto, home, health, and business insurance companies.
They can also be hired by self-insured organizations and government agencies.
Who do Claims Specialists work with?
Claims Specialists work directly with a client who experiences an accident or damage.
They can also collaborate with Claims Adjusters and attorneys, and negotiate with insurance agencies.
How to become a successful Claims Specialist?
In order to become successful Claims Specialists, candidates must obtain a Bachelor’s degree in accounting, business, or finance.
They also need to work on their knowledge and experience and develop skills necessary for this position, such as communication, negotiation, problem-solving, organization, and attention to detail.
How much do Claims Specialists earn per year?
Claims Specialists earn between $23,500 and $52,500 annually.
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