Will “Medical Insurance Claims Processor” be Automated?

Core Skills & Abilities

• Pay small claims.

• Notify insurance agent and accounting department of policy cancellation.

• Calculate premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards.

• Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.

• Contact insured or other involved persons to obtain missing information.

• Modify, update, or process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.

• Compose business correspondence for supervisors, managers, and professionals.

• Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.

• Collect initial premiums and issue receipts.

• Transmit claims for payment or further investigation.

• Organize or work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.

• Post or attach information to claim file.

• Prepare insurance claim forms or related documents, and review them for completeness.

• Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.

• Review insurance policy to determine coverage.

• Enter insurance- and claims-related information into database systems.

• Process, prepare, and submit business or government forms, such as submitting applications for coverage to insurance carriers.

• Interview clients and take their calls to provide customer service and obtain information on claims.

• Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.

• Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.

• Process and record new insurance policies and claims.

• Obtain computer printout of policy cancellations, or retrieve cancellation cards from file.

• Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.

• Calculate amount of claim.

• Correspond with insured or agent to obtain information or to inform them of account status or changes.