Claims Assistant Job Description, Skills, and Salary
Get to know about the duties, responsibilities, qualifications, and skills requirements of a claims assistant. You can use our job description template in this article to produce your own. We also provide you with information about the salary you can earn as a claims assistant.
Who is a Claims Assistant?
A claims assistant primarily handles the processing of insurance claims. They help with the procedure, complete paperwork, handle mail, and answer phones. A Claims Assistant is assigned administrative and clerical duties, thus certain abilities are required for this position. The management of the claims procedure at their firm is the responsibility of claims assistants. They might take part in anything from the initial intake through the inquiry and resolution. Claims assistants need to be proficient in legal jargon and have excellent communication abilities.
The management of an organization’s insurance claims procedure falls within the purview of claims assistants. They may be engaged in a range of responsibilities, from intake to investigation to resolution, as part of their multifaceted function. You will have a wide range of possibilities for your workplace if you are interested in this career path. Work is available in insurance firms, medical facilities, and governmental organizations. A claim assistant may make a respectable living by working the normal 40-hour workweek.
Claims Assistant Job Description
Below are the claims assistant job description examples you can use to develop your resume or write a job description for your employee. Employers can also use it to sieve out job seekers when choosing candidates for interviews.
The duties and responsibilities of a claim assistant include the following;
- Examine incoming claims to evaluate eligibility for coverage by the insurance policy’s conditions.
- Evaluate medical invoices and send them to providers so they may be corrected if necessary.
- Resolve customer support concerns as well as receive and process new coverage applications.
- Updates on claim status, payment schedules, and other pertinent information are sent to the insured.
- Process claims in cooperation with multiple divisions of an insurance business.
- Create thorough reports and a summary of claims activity for management’s internal usage.
- Coordinate with the claim’s lawyers, doctors, and other participants.
- Maintain claim databases that include data on claim status, settlements, and associated information.
- Work under general supervision and uses a fair amount of discretion in carrying out job-related activities.
- Account for handling sensitive and private information and documents properly.
- Carry out crucial work duties either with or without suitable accommodation.
- Open incoming mail, datestamps it, organizes it, and distribute it.
- Establish correspondence between mail and files or faxed documents to the Imaging Center for attachment to digital files.
- Provide administrative assistance for the Catastrophe Storm Team, which often demands long-distance travel;
- Train freshly recruited Claims Assistants. provide a guide on the duties of a claims assistant.
- Carry out further relevant tasks as directed by the Branch Claims Manager or Branch Claims Supervisor.
- Find all of the insured’s policies via research.
- Help Claims Rep in fact-checking news stories, document files, and coverage.
- Inform clients about the procedures needed to resolve disputes.
- Update the claim system with fresh losses.
- Investigate recent losses.
- Identify fresh losses.
- Assist with front desk phone coverage.
- Answer phones and direct calls while managing, organizing, and routing incoming/outgoing mail.
- Organize and file closed claim files.
Qualifications
- Know Word, Excel, and PowerPoint in Microsoft Office.
- Excellent keyboarding.
- A polished telephone manner, and effective oral and written communication abilities.
- The capacity to operate both individually and in a team.
- General understanding of the regulations and processes governing workers’ compensation claims.
- The capacity for close attention.
- Exceptional writing, grammar, and proofreading abilities.
- The capacity to multitask and operate effectively under pressure in a fast-paced workplace.
- The capacity to follow instructions and make judgments.
- Must have the willingness to acquire new computer skills.
- Good telephone manners and communication abilities.
Essential Skills
- Organization: The capacity of the organization is the capacity to track documents, papers, and other objects. You can be in charge of submitting paperwork or keeping track of client data as a claims assistant. You can keep on top of your job and make sure that the relevant information is accessible when needed by having great organizing abilities. In your personal life, you may employ organizing abilities to keep your home running smoothly and relieve stress.
- Coding: Information is represented by symbols in a process called coding. You may have to classify medical jargon or other information as a claims assistant for use in an insurance claim. For instance, you may code “arm” as “A,” “broken” as “B,” and “therapy” as “T” if a patient has a broken arm. This enables the computer system to comprehend the patient’s treatment demands and the appropriate payment amount.
- Data entry: Data entry is the process of entering information into a computer system. You may have to input information about clients’ insurance claims and their details as a claims assistant. This calls for accuracy as well as quick typing or the use of an electronic signature pad. By enrolling in online office administration classes or finishing a data processing certificate program, you may hone your data entry abilities.
- Processing Claims: Claim processing assistants often work for their companies. This entails looking through a claim’s specifics, investigating its veracity, and figuring out how much the insurance provider should reimburse the client. Strong organizing abilities are essential if you want to manage all of your papers and files. When going through papers and determining whether or not a claim is accepted, you need also pay close attention to detail.
- Verification of Insurance: Verifying an individual’s insurance information is the procedure of insurance verification. This may include checking their insurance number, firm name, and insurer contact information. It’s crucial to confirm this data to provide correct claims to the insurance companies of your clients. You may also need to follow up on the specifics of the claim or ask the consumer for further information.
- Healthcare Billing: To file claims for payment, medical billing involves keeping track of patient information and insurance information. This job is often done by medical assistants, thus having a solid grasp of medical jargon and how the healthcare system works, in general, is crucial. Online classes are one way to study medical billing, but you may also learn on the job by getting a position as a medical assistant first.
- Solving issues: Having the capacity to recognize and address problems is problem-solving. You would have to address issues with customer service or insurance claims as a claims assistant. For instance, you may be in charge of resolving a customer’s claim-related problem by coming up with solutions that are acceptable to all sides. When locating information on the issues or inquiries of clients, you may put your problem-solving abilities to play.
- Consumer Assistance: Because claims assistants often engage with consumers, customer service skills are crucial. They often respond to client calls and emails, therefore they must have outstanding customer service abilities to make sure that their contacts are helpful and professional. Customer service also entails promptly and completely addressing customer difficulties, which calls for the capacity to pay attention to clients’ worries and provide answers.
- Denials Control: Understanding when a customer’s claim can be rejected and knowing how to respond to that circumstance is known as denial management. Included in this are justifications for why an insurance company could reject a claim, contacts for further sources of assistance, and support if their claim is accepted. A claims assistant who is skilled at managing rejections can provide clients with useful information and make sure they get the benefits they are due.
- Management of time: The capacity to schedule and carry out work in a manner that guarantees you meet deadlines is known as time management. Time management abilities are crucial as a claims assistant since they enable you to finish your task on schedule and guarantee that consumers get their pay right away. You may need to prioritize this assignment over others to submit it by the due date, for instance, if you’re dealing with an adjuster who wants to approve a claim within seven days.
- Authorizations: The permissions required to process claims are known as authorizations. A claims assistant must understand how to ask managers and supervisors for authorization and how to read authorization forms. Authorizations include getting the go-ahead to file a claim, submitting paperwork for review, and seeking money or other resources.
- Detail Observation: The ability to pay close attention to details and verify their accuracy is referred to as detail observation. You may need to check papers for correctness as a claims assistant or confirm that data input into a computer system is accurate. This ability may assist in making sure that your business gives clients accurate information about its rules and that all required documentation is submitted properly.
- Communication: The capacity for clear and intelligible information transfer is referred to as communication. You may have to speak with customers over the phone or through email as a claims assistant. You should be able to effectively explain complicated concepts to your customers so that they are aware of both their rights and obligations as well as what to anticipate from the insurance provider.
- Flexibility: The ability to alter course when necessary. By the demands of the business and its customers, you as a claims assistant may need to adjust your schedule or collaborate with several departments. You can adapt fast and perform effectively in any scenario by being flexible. Additionally, as consumers’ requirements are subject to change over time, flexibility is essential while dealing with them.
- Appeals: Customers may decide to submit a claim for several reasons, including appeals. For instance, enticing features and advantages might persuade clients to buy insurance from your business. You can be in charge of producing appealing marketing materials for prospective clients as a claims assistant. Additionally, you use appeals while conversing with clients about their claims. You may increase the number of sales you complete and lower the number of claims your firm gets by learning how to present information attractively.
- Posting of Payment: An insurance company claims assistants must be able to post payments. This entails accurately inputting the necessary data into a computer system and making sure that everyone gets their money on schedule. To uncover accounting issues and make the necessary repairs, you may also need to reconcile accounts.
How to Become a Claims Assistant
- Get a high school diploma or something like A high school diploma or its equivalent is often required for claims assistant employment. Although some businesses would favor applicants with a college degree, this isn’t always the case. If you’re thinking about going to college and want to work as a claims assistant after you graduate, find out what kinds of insurance and risk management courses are offered at your neighborhood college or university.
- Consider finishing a certificate program for claims assistants: The minimum education needed for this profession is a high school diploma or its equivalent, however, many companies prefer claims assistants to have some college education. You may acquire the skills and information necessary to be successful in this position by earning a certificate in insurance and claims assistance. These courses are offered in universities, colleges, and vocational schools. Coursework in areas including basic business practices, risk management, property and casualty insurance, and personal injury protection are all included in the one- to two-year programs.
- Become more experienced by working in the insurance sector: Having experience in the insurance sector will help you better grasp how claims departments function and will provide you with in-depth knowledge of the business. This experience may be obtained via internships or entry-level jobs that teach you about various insurance plans, the claims-processing procedure, and client interaction.
Working in an insurance office may also help you choose if you’d want to be a claims adjuster rather than a claims assistant.
- Enhance your computing skills: Word processing and spreadsheet software are only two of the many computer tools that claim assistants need to be proficient with. It’s also beneficial to be familiar with the databases and other specialized technologies that insurance firms employ. Although many businesses provide training on how to utilize the company’s software, having excellent computer skills is crucial for this position.
- Know the fundamentals of insurance coverage and policies: You must comprehend the fundamentals of how these different forms of insurance operate since claims assistants deal with a wide range of insurance plans and coverage. For instance, if you work in the property and casualty sector, you must understand how storm or fire damage claims are processed. Understanding how various insurance coverages operate will help you perform your duties more successfully.
Where to Work as a Claims Assistant
Work environments for claims assistants include insurance corporations, governmental organizations, and hospitals. They normally put in a 40-hour workweek, however, some may need to work extra hours on the weekends or in the evenings to keep up with their workload. To look into claims or interact with customers, they could also travel to other regions. Claims assistants deal with a range of individuals, such as claimants, attorneys, and insurance adjusters. They must be able to manage a lot of work and operate well under pressure to finish projects on time.
Claims Assistant Salary Scale
In the UK, the typical claims assistant makes £25,000 a year, or £12.82 an hour. Most experienced professionals earn up to £34,969 per year, while entry-level roles start at £22,500.
In Canada, the typical claims assistant makes $39,975 a year, or $20.50 an hour. Most experienced professionals may earn up to $47,366 per year, while entry-level roles start at $31,200.
Australia’s average claims salary is $43.89 per hour or $85,591 annually. Most experienced workers can earn up to $117,249 per year, while entry-level positions start at $68,169 annually.
