Claims Processor

Claims processors, (basically a specialist clerical function), working mainly as Financial and Insurance Clerks, of sorts.

Dealing with customers (claimants), other stakeholders (insurance company for example) and documentation, policies and procedures, is first priority for CPs. Most of these roles and functions are taking on an almost administrative specialized, customer service representative/ processing agent type character, based in call center-type environments, to handle the recording of the necessary details of the claim, allowing adjusters to spend more of their time investigating claims.

New technology also is reducing the amount of time it takes to complete a claim, thereby increasing the number of claims that one adjuster can handle. However, as long as more insurance policies are being sold, to accommodate a growing population, there will be a need for adjusters, appraisers, examiners, and investigators. Further, as the elderly population increases, there will be a greater need for healthcare, resulting in more claims. Employment outlook is rated as good, in the years to come.

Several of the main duties and tasks might claims processors are faced with, include any and/or all of the following:

• Verify and generally investigate circumstances surrounding insurance claims, to determine validity of claim
• Inspect automobile, home or other property damage
• Take statements and consult with claimants, accident witnesses, doctors and other relevant individuals and examine records or reports
• Determine amount of loss or damages covered by insurance policies
• Negotiate settlement of claims
• Prepare adjustment reports.
• Review, examine, calculate and authorize insurance claims investigated by insurance adjusters
• Examine adjusters' reports and similar insurance claims or precedents to determine extent of insurance coverage
• Ensure claims are valid and settlements are made according to company practices and procedures
• Consult lawyers, doctors or other relevant individuals to discuss insurance claims
• Approve automobile, fire, life, disability, dental or other insurance claims.

For career entry-level positions, secondary school completion, a college diploma or a bachelor degree, OR even several years of experience in a claims department or general insurance, is considered ample. On-the-job training and completion of insurance industry courses and training programs are required. Candidates with good administrative, claims processing exposure and experience in research, review and resolution of claims cases, will fare better than those with no relevant and/or industry experience. In this support-role, you might enjoy or be familiar with bearing the responsibility for the timely resolution of issues and the possible coordination of the resolution with Technology, Claims and Customer Service.

High-school diploma candidates can still find employment quite readily in junior and entry-level positions. It appeals to those individuals with a strong sense of accuracy and eye for detail, combined with strong interpersonal skills, technology literacy and hands on use of various software applications and technology platforms, fact-finding and problem solving skills.

Careers in billings, coding, transacting, information verification, claims management centers around pivotal transactional process, still very prevalent in modern business, especially in the medical, dental and insurance sectors of the economy. Increasingly, these services are either outsourced, automated, online, or handled by coding and processing experts, specifically trained and certified to execute claims in a timely, responsive and accurate manner.

Related occupations include: Property-casualty insurance adjusters and life and health insurance examiners who must determine the validity of a claim and negotiate a settlement. They are also responsible for determining how much to reimburse the client.

Insurance claims processing training, medical billing and coding, claims processor training programs, etc., are available via various distance learning/in-classroom, correspondence, online programs and colleges (online sources).

Job-boards: YahooJobs.com, Careerbuilder.com, Monster, Workopolis and many others will have search capability by occupational category or job-title, targeted and localized/global keyword-searches (depending on your need and requirements) and more at your fingertips.

It is also a licensed profession for independents. Career advancement might come in the form of completion of additional (CE) educational programs, through the National Insurance Institute or its provincial counterparts. For professional recognition as an Associate of the Insurance Institute of Canada (A.I.I.C.) for example and, with additional university courses, as a Fellow of the Insurance Institute of Canada (F.I.I.C.), most HQ's of life, health, and property and casualty insurance companies will also be able to provide you with more information.

Occupations similar to those of claims adjusters, appraisers, examiners, and investigators (also in this category), include: cost estimators; bill and account collectors; medical records and health information technicians; billing and posting clerks; and credit authorizers, checkers, and clerks, as well as bookkeeping, accounting, and auditing clerks.

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