Insurance claims processing clerks work with insurance agencies to assist with the paperwork in a claims department. They review claims forms and determine the accuracy of the information before submitting a claim. They work with computers and make phone calls to customers and businesses.
When you’re in the beginning stages of writing your insurance claims processing clerk job description, you’ll need to review common qualifications for this job. Most individuals in this role have at least a high school diploma. Some companies require their clerks to have a college degree in a related field.
Then, you’ll need to review some of the other essential skills for the job. Insurance claims processing clerks must be highly organized and efficient. They must also be able to meet deadlines and have excellent attention to detail. Take a look at the insurance claims processing clerk job description template below to get more ideas.
Insurance Claims Processing Clerk Job Summary
Looking for a challenging work environment where you can help patients access top-quality health care? Our organization is seeking a highly accurate and hard working insurance claims processing clerk to join our claims department. In this role, you would be working to get patients’ paperwork through our system more efficiently, and you would be checking for claim form completion and submitting forms for final approval to help patients get timely coverage for needed health treatments. You could make a difference in people’s lives by ensuring they get access to covered services and improving wait time for insurance coverage approval. As an insurance claims processing clerk, your top attention to detail and your organizational skills could make an impact on the lives of others.
- Check over insurance claims forms as they are submitted and review each section for accuracy and completeness
- Confirm that the patient and the treatment or prescription are covered parts of the insurance plan by researching the plan details using a computerized database or calling the physician’s office
- Submit each insurance claim after verification for final processing via an electronic submittal form system and review the reception of the claim with a final check
- Interpret the language in the overview of benefits summary explanation for the insurance policy and apply interpretation to the claims review process
- Update policy forms and claims information when insurance coverage changes have occurred and notify appropriate parties of the changes when necessary
- Maintain knowledge of all appropriate medical insurance coverage laws in the local, state and federal jurisdiction area when reviewing claims submissions
- Follow all required medical privacy laws when discussing private information about patients with physicians, healthcare managers or other staff members in the insurance agency
Job Skills & Qualifications
- High school diploma
- One to two years of experience working in claims processing
- Knowledge of the health insurance industry
- Experience working with a high-volume phone system
- Bachelor’s degree in finance, accounting or a related field
- Excellent customer service skills
- Proficiency in Microsoft Office
Insurance Claims Processing Clerk Job Responsibilities
The most effective job descriptions include detailed overviews of the responsibilities of an open position. Start this section of an insurance claims processing clerk job description by listing the duties that an employee should fulfill every day. You should address specific responsibilities, such as checking claims for accuracy and completeness, and may also want to describe the contributions of a claims processing clerk to broader operations.
A bullet-point list is the most accessible way to present all of these requirements in an insurance claims processing clerk job description. Keep the focus on the actions an employee will need to perform by starting each line with a strong action verb. There is no need to mention general tasks like checking email. Include no more than eight bullet points to provide potential applicants with a concise but relatively complete representation of this position.
Here are several insurance claims processing clerk job responsibilities that you might consider including:
- Check claims for accuracy and completeness prior to processing in insurance database
- Review forms and attached or related documents to ensure that all necessary information is available
- Identify missing information and forward requests to claim service representatives or agents
- Ensure that input and results generated by insurance ratings systems are accurate
- Add or adjust billing codes where necessary
Insurance Claims Processing Clerk Job Specifications
Applicants rely on the qualifications and skills section of an insurance claims processing clerk job description to understand the experience, education and skills required to fill this position. These specifications can be a determining factor for the types of resumes you receive. In general, the clearer you can make the specifications for this position, the better the pool of applicants from which you can select a new hire.
You might obtain the best results by dividing the specifications into minimum and preferred skills. This can help jobseekers determine whether it is worth their time to apply and decide which aspects of their background to emphasize on their resumes. You are more likely to receive applications that meet or exceed the specified standards if this list is specific and easy to read.
Consult with an insurance agent or claims manager if you are unsure about how to weigh the skills required for this position. You may also want to make sure that these specifications correspond with the requirements section of your insurance claims processing clerk job description.
Here are a few general insurance claims processing clerk job specifications:
- High school diploma or equivalent required
- Verbal and written communication skills
- Familiarity with insurance billing codes and ability to find and fix errors
- Organization and exceptional time-management skills with a capacity for multitasking
- Proficiency with office and electronic communication software