A claims clerk is responsible for processing insurance claim forms and related documents, ensuring policyholder information is accurate and complete before claims are approved for payment[3]. They complete clerical tasks such as opening, counting and sorting through incoming paper claims, answering telephones, taking messages, and utilizing computer software to retrieve case-related data[1].
Key job duties of a claims clerk include:
- Processing insurance claim forms and verifying policyholder information for accuracy and completeness[3].
- Approving or rejecting claims based on established guidelines and policies[3].
- Maintaining and updating financial records related to claim files[5].
- Communicating with policyholders, insurance agents, and healthcare providers to gather or clarify information[3].
- Entering and retrieving claims information from database systems[3].
- Maintaining accurate records of claims processed and payments made[3].
- Sorting and organizing office and claim-related paperwork[1].
- Offering customer support and answering inquiries from clients[5].
Additional duties may involve:
- Comparing identifying information and counts of claims from incoming mail and sorting such mail[7].
- Coding and entering information into the computer or claims system[7].
- Preparing claim files for litigation support or attorney review[7].
- Providing backup for critical, time-sensitive deadlines and helping with process improvements[7].
Claims clerks are expected to demonstrate strong attention to detail, possess organizational and communication skills, and be able to effectively use computer programs. Typically, the entry requirement is a high school diploma or equivalent, and prior experience in similar roles is often preferred[3].