Claims processors - also called claims adjustors - are responsible for accurately and efficiently entering and processing claims for their organization. Claims processors generally work in the insurance industry and they work for many types of companies (such as those specializing in health insurance, automobile insurance, and/or home insurance). These claims may be received via the computer, on paper, or over the phone; processed claims create approvals (which send payment) or denials. Claims processors may be required to answer phone calls from policyholders related to claims, and they must be able to answer such calls quickly and accurately. They typically work in an office setting during normal business hours. If they answer phone calls, claims processors may be required to work on weekends and evenings. This position may be part time or full time, and some companies allow claims processors to work from home. Claims processors generally work seated at a computer workstation for extended periods of time.
Claims processors are usually required to have at least a high school diploma or equivalent, and some employers may require a postsecondary degree. Once hired, claims processors are often required to take additional classes to become proficient within their area of insurance and the policies of their industry. Claims processors must be familiar with basic computer use and claims processing software. They must pay excellent attention to detail and have the ability to multitask under deadline. These professionals must have outstanding customer service and communication skills.
Claims Processor Tasks
- Coordinate claims with Medicare and other group insurance carriers.
- Audit other team member's claims as needed.
- Determine proper payees for benefits in order to discharge company's liabilities.
- Approve claim payments.
- Process flexible spending account claims of any type for multiple welfare plans according to established rules and guidelines.