CLAIMS CLERK JOB DESCRIPTION

A Claims Clerk is the administrative backbone of an insurance claims operation. State regulatory filings, check processing cycles, and claim file integrity all depend on someone who catches the error before an examiner ever opens the case. In property and casualty and third-party administrator environments, this role owns the intake pipeline: sorting and indexing incoming documents, entering and correcting claim data, and routing work to the right examiner or analyst. Accuracy at this level directly shapes whether a carrier meets its compliance obligations to state bureaus.

As the Claims Clerk, you will maintain the data accuracy, document flow, and client communication that keep an insurance claims operation running within regulatory and corporate service standards. You will support a team of examiners and analysts, working within established productivity and quality benchmarks set by both state compliance requirements and internal claim service commitments.

Career Impact: Hands-on exposure to state regulatory filing requirements and TPA claim workflows builds a foundation that accelerates movement into examiner and analyst roles.

Business Impact: Accurate claim intake and data correction directly determine whether carriers and clients meet state bureau deadlines and avoid compliance penalties.

Growth Opportunity: Mastery of claim indexing, void and stop-payment processing, and quality control standards opens a defined path toward Claims Examiner or Claims Analyst positions.

• Enter and correct claim data in the claims management system to ensure accurate and timely processing.
• Index incoming claim documents received via electronic fax, email, and mail into the appropriate claim files.
• Build new claims in the system and assign them to the correct examiner or analyst for handling.
• Prepare and distribute state regulatory reports and monthly bureau filing requirements on schedule.
• Process check voids, stop-payments, and offsetting coding corrections within established daily and weekly cycles.
• Monitor team email inboxes and respond to inquiries from internal staff, clients, and vendors within service commitments.
• Gather and verify supporting documentation from claimants, providers, and carriers to ensure complete claim records.
• Audit completed data entry for accuracy and flag discrepancies to supervisors before files advance to review.

• Bachelor's degree in business administration, insurance, or equivalent work experience.
• 1 or more years of claims support, data entry, or related office experience, with demonstrated attention to detail in a production environment.
• Basic knowledge of insurance claim processing procedures and state regulatory filing requirements.
• Ability to navigate multiple database systems and software applications concurrently and efficiently.
• Strong written and verbal communication skills for interacting with adjusters, clients, and external vendors.
• Demonstrated ability to meet productivity and quality standards within structured deadlines.
• Proficiency with spreadsheet and document management tools for reporting and record-keeping.
• Ability to maintain strict confidentiality of claim and customer information in compliance with applicable privacy standards.

• Prior experience in a third-party administrator or property and casualty insurance environment.
• Familiarity with state bureau reporting processes or regulatory compliance requirements for insurance carriers.
• Associate degree or coursework in insurance, business administration, or a related field.
• Experience supporting claims examiners or analysts in a team-based production environment.

• Daily data entry volume and error rate, measuring accuracy of claim records before examiner review.
• Percentage of state regulatory reports submitted on or before required filing deadlines.
• Check processing cycle completion rate, tracking voids and stop-payments resolved within the weekly schedule.
• Inbox response time for client and adjuster inquiries, measured against team service commitment windows.
• Document indexing accuracy rate, reflecting the proportion of incoming mail correctly matched and filed to active claims.
• Typical tools: Claims management systems (commonly Guidewire or Duck Creek); document repositories (commonly OnBase); productivity suites (commonly Microsoft Office, Excel).

• Base Salary Range: $36,000 to $48,000 per year
• Bonus: Discretionary annual bonus, typically 3 to 5 percent of base
• Equity: Not typically offered at this level
• Health Benefits: Medical, dental, and vision coverage; employer contribution standard
• PTO: 10 to 15 days annually, plus standard holidays
• Common Perks: Employee assistance program, structured onboarding, internal advancement pathways

Figures are estimates based on general US market benchmarks and may be outdated. Adjust based on location, company size, and seniority level.

Candidates are considered for employment without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other characteristic protected under applicable federal, state, or local law. Reasonable accommodations are available to qualified individuals with disabilities upon request. Employment offers are contingent on successful completion of a background check. Applicants must be authorized to work in the United States.

The Claims Clerk owns regulatory and quality assurance reporting by gathering data from claims systems, correcting records, and delivering monthly state filing requirements. Working closely with clients and adjusters, the Claims Clerk supports a team focused on data accuracy and process improvement, enabling the organization to meet compliance obligations and maintain reliable reporting outputs.

Key Responsibilities

• Gather information from the ERS claims system and build various reports, including quality assurance and regulatory reports.
• Prepare reports for clients.
• Make corrections to claims data to ensure all data elements are accurate.
• Assist in automation and innovation of current reporting processes.
• Review processes for potential automation or improvement opportunities and make recommendations to supervisor.
• Answer client and adjuster inquiries, including topics regarding system and access questions.
• Assist in onboarding of new client data and complete monthly reporting requirements for states.

Required Qualifications

• Associate degree in insurance, business administration, or equivalent relevant experience.
• Two or more years of claims support, data reporting, or related experience.
• Basic knowledge of insurance claim processing, procedures, technology, and state and regulatory bureau filing processes.
• Strong computer skills including Microsoft Office Suite, specifically Excel, and knowledge of Microsoft SQL preferred.
• Good communication, interpersonal, research, and analytical skills.
• Ability to work effectively in a team and independently.

Embedded within the Data Technical Services team, the Claims Clerk delivers accurate claims support by entering and correcting claim records across multiple systems and platforms. Working closely with claims operations staff, the role ensures that provider and contract information is updated correctly so that claims are processed and paid without error.

Core Functions

• Enter claims into the system and update provider and contract information using appropriate platforms.
• Research, identify, and obtain claim data needed to help process claims accurately and efficiently.
• Navigate system tools and screens efficiently using keyboard skills, macros, and shortcuts.
• Make phone calls to obtain correct or corrected claim information.
• Consistently meet established productivity, schedule adherence, and quality standards.

Qualifications & Experience

• High school diploma or GED or higher.
• 1 or more years of experience in an office setting using telephone and computer as primary instruments.
• Data entry experience, including experience working with medical claims.
• UHOPS experience.
• Basic proficiency with computers and Windows PC applications, including the ability to learn new and complex systems.

Reporting to claims leadership, the Claims Clerk handles data entry, review, and status determination for dental claims while applying ADA regulatory requirements and company-specific guidelines. Partnering with internal teams and external customers, the Claims Clerk contributes to consistent production quality and a positive service experience across all claim interactions.

Primary Duties

• Complete data entry of new dental claims and review and process dental claims while maintaining quality and production expectations.
• Research, analyze, and use available resources to make accurate and timely claims decisions.
• Independently determine appropriate claim status, taking into consideration regulatory and ADA requirements.
• Promote positive customer service through prompt, accurate, and courteous responses to internal and external customers.
• Identify and utilize best practices to ensure consistency and optimal performance in a team-based environment.
• Support various project work as needed.

Skills & Qualifications

• High school diploma or equivalent.
• Data entry experience dealing with all types of plans and claims required.
• Knowledge of dental terminology and ADA codes required.
• Typing speed of at least 35 wpm net on a computer keyboard.
• Strong communication, analytical, problem-solving, and decision-making skills with high attention to detail and ability to shift priorities.
• Good organizational skills with the ability to work under pressure, maintain confidentiality, and meet timelines.
• Bilingual in Spanish and English a plus.

Sitting at the intersection of administrative support and claims operations, the Claims Clerk shapes document intake, coding corrections, and financial data verification across a multi-function office environment. Operating across mail processing, inbox management, and reimbursement workflows, the Claims Clerk enables claim staff to process cases accurately by maintaining complete and current records throughout each stage of the operation.

Duties

• Provide incoming mail support including opening, sorting, delivery, scanning, and indexing documents to claim files.
• Operate office equipment including computers, printers, copy machines, fax machines, and mailing equipment.
• Monitor Operations department email inboxes and distribute requests to appropriate claim staff.
• Process offsetting entry work on coding corrections and voided or stop-paid checks.
• Enter data, maintain updated records, review and process reimbursements, and verify financial data such as tax identification numbers.
• Communicate with vendors, customers, and colleagues and provide exceptional customer service.

Experience & Qualifications

• High school diploma.
• Minimum 6 months of experience in an insurance claims department or related office environment.
• Knowledge of basic bookkeeping and financial transactions.
• Basic understanding of business technology.
• Working knowledge of MS Office and databases.
• Strong organizational, multitasking, and decision-making abilities with a detail-oriented approach.

A key member of the claims support team, the Claims Clerk builds accurate claim files, manages correspondence, and ensures compliance with service commitments on behalf of claim personnel and clients. Collaborating across claim staff, client-specific teams, and reception functions, the Claims Clerk delivers clerical quality that directly reflects the organization's service standards and client satisfaction outcomes.

Functions

• Match mail for assigned accounts, follow up on bills, and file claim mail and related documents.
• Set up designated claim files and complete all setup instructions as requested.
• Summarize correspondence and medical records in claim log notes and file in the appropriate claim as directed.
• Retrieve and maintain closed claim files in storage and photocopy documents as needed.
• Return provider and other calls as directed and provide support to claim staff on client-specific teams.
• Back up for receptionist and ensure compliance with service commitments established by the team.

Requirements

• Knowledge of all lower-level claim position responsibilities.
• Excellent oral and written communication skills with the ability to communicate clearly both internally and externally.
• Strong organizational abilities with capacity to coordinate, prioritize, and work with minimum supervision.
• Detail-oriented and self-starter with flexibility, accuracy, and initiative in a constantly changing environment.
• Reliable attendance within client service hours, discretion, confidentiality, and responsiveness to internal and external client needs.

Accurate and timely claims administration depends on the Claims Clerk, who builds claims in the system, verifies documentation, and delivers prompt service to internal and external clients by phone and email. Serving as a key point of contact within the Claims team, the role supports carrier policy compliance and keeps claim activity reporting current so the broader operation can respond to trends and workload shifts.

Accountabilities

• Review all incoming documentation for accuracy and gather and verify documentation from appropriate parties.
• Build claims in the system and assign them to the appropriate team member for processing.
• Administer team email inboxes, respond to inquiries by phone and email, and escalate complex issues as needed.
• Update claim statuses, record additional information, and report on claims activity and trends as assigned.
• Build understanding of industry regulations and carrier insurance policies and their impact on filed claims.

Position Requirements

• High school diploma or GED equivalent.
• 1 or more years of office experience preferred.
• Experience in transportation, shipping, or sales in a 3PL environment preferred.
• Experience with G Suite and Jira preferred.
• Strong organizational skills, attention to detail, and written and verbal communication skills.
• Ability to multitask, manage competing deadlines, and take on new challenges with a strong learning aptitude.

As the Claims Clerk, this role leads document sorting, claim indexing, and check processing tasks that prepare claim information for review by examiners and analysts. The claims operation relies on this work to maintain HIPAA-compliant records, meet daily and weekly reporting cycles, and route incoming correspondence to the right examiner without delay.

Scope of Work

• Sort and import claim documents received via electronic fax or email for ingestion into the document repository system.
• Research and identify unmatched mail items and forward to the appropriate department or examiner.
• Index new claims and input initial benefit lines into the mainframe system for new claims.
• Support examiners and analysts by creating and sending letters for requested information.
• Complete the Check Pull report daily and process the weekly interest report.
• Process voids and stop-payments for claim checks and maintain customer privacy in accordance with HIPAA standards.

Minimum Qualifications

• High school diploma or equivalent required.
• Previous data entry experience.
• Work experience in a production environment preferred.
• Strong computer literacy with proficiency in Microsoft Office and Excel, and high technical aptitude to learn new systems quickly.
• Excellent typing skills with a high level of attention to detail and accuracy.
• Strong organizational, time management, and multitasking skills with flexibility to adapt to changing demands.
• Team player with the ability to work independently, make autonomous decisions, and meet stringent deadlines.