What does a Claims Processor do?
Claims processors work in the insurance industry and handle insurance claims. They review claims submissions, obtain and verify information, correspond with insurance agents and beneficiaries, and process claim payments. They communicate with insurance agents and beneficiaries and prepare claims forms and related documentation. They are responsible for reviewing claims submissions and verifying the information contained therein.
Claims processors record and maintain insurance policy and claim information in database systems and determine policy coverage while calculating claim amounts. Claims processors process any claim payments when applicable and must ensure they comply with federal, state, and company regulations and policies. Claims processors need at least two years of experience as a claims processor or similar and working knowledge of the insurance industry and relevant federal and state regulations.
- Effectively manage a portfolio of various type of claims.
- Update and maintain claim files to ensure complete records.
- Respond timely to internal and external inquiries for information relative to claims.
- Review, prepare, create, and/or send letters, reports, and forms.
- Communicate claim action/processing with claimant, client and appropriate medical contact.
- Identify notification issues, coordinates resolution and takes corrective actions as needed.
- Engage and address any customer inquiries related to lien/bond claim notices sent to property owners, general contractors, and subcontractors.
- Collaborate with the claim handlers in preparing the claim notices.
- Maintain action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution. escalates issues as needed.
- Provide support and assistance in updating reinsurance systems and information.
- Bachelor's Degree in business or computer science.
- Exhibit strong critical thinking and problem solving skills.
- Demonstrated careful attention to detail.
Claims Processor Salaries
Average Base Pay
Claims Processor Career Path
Learn how to become a Claims Processor, what skills and education you need to succeed, and what level of pay to expect at each step on your career path.
Years of Experience Distribution
Claims Processor Insights
NFU Mutual“No career opportunities and if you do get on your put on secondment which they can revoke at any minute”
Direct Line Group“level job was becoming ridiculous and because of these problems I know many good handlers who also left.”
State Farm Mutual Automobile Insurance“The pay is decent and when I first started we got a lot of raises.”
HealthComp“Not sure if this is because I'm in training or if this happens even afterward.”
Collective Health“If you don't give a weeks notice when trying to use your accrued PTO you receive disciplinary points.”
HomeServe UK“Loved working with my team we had such a great laugh when together even when its call after call.”
Prudential“Pay is good but as a human with bill I will always want more pay.”
Gallagher“People are fun and good”
Frequently asked questions about the role and responsibilities of a Claims Processor
- Claims Analyst
- Claims Adjuster
- Claims Examiner
- Claims Manager