CLAIMS SPECIALIST SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
The Claims Specialist adept in claim adjusting and corporate claim processes possesses an understanding of general claim procedures and loss prevention programs. This role requires effective communication with various management levels and the application of jurisdictional regulations and corporate policies. Strong organizational and time management skills, coupled with proficiency in Microsoft Office and claims management systems, are essential.
Essential Hard and Soft Skills for a Standout Claims Specialist Resume
- Claims Processing
- Insurance Policy Analysis
- Legal Compliance Knowledge
- Data Entry Proficiency
- Financial Analysis
- Risk Assessment
- Software Skills
- Medical Coding
- Report Writing
- Knowledge of State and Federal Insurance Regulations.
- Attention to Detail
- Communication Skills
- Negotiation Skills
- Problem-Solving
- Empathy
- Time Management
- Organizational Skills
- Adaptability
- Decision-Making
- Customer Service Orientation.
Summary of Claims Specialist Knowledge and Qualifications on Resume
1. BA in Business Administration with 3 years of Experience
- Fluent in both English and French ( written and verbal)
- Previous experience in a similar role requiring good judgement skills
- Proven ability to manage multiple deadline driven tasks
- Excellent time management skills
- Proven ability to make decisions independently
- Proficiency in Microsoft Office (Word, Excel, Outlook, and Teams)
- Strong customer service skills
- Demonstrate good analytical and problem-solving skills with the ability to identify cause and effect and communicate results in a structured manner
- Proficient in Microsoft Office applications, including Outlook, Word and Access
- Highly Proficient in Microsoft Excel
- Strong PC skills including proficient typing and keyboard skills
- Solid organizational and time management skills
- Strong attention to detail and proven analytical ability
2. BA in Healthcare Management with 2 years of Experience
- Strong attention to detail and consistency.
- Ability in the use of Microsoft Office software, including Outlook, Word, and Excel.
- Ability to make high-level, risk-based credit decisions.
- Customer service driven, responsive to client issues and concerns.
- Solid written and verbal communication skills.
- Ability to multitask and effectively manage time.
- Desire to take personal responsibility to complete tasks and solve problems.
- Ability to perform tasks and complete projects with minimal supervision.
- Ability to communicate effectively both in written and verbal form.
- Experience in workers' compensation claims processing, claims investigation or related area within an office environment.
- Strong written and verbal communication skills
- Ability to interact with internal and external contacts.
3. BA in Finance with 3 years of Experience
- Experience with claim adjusting and/or corporate claim
- Understanding of general claim procedures and loss prevention programs
- Strong oral and written communication skills
- Ability to interact and communicate with all levels of management
- Ability to apply jurisdictional regulations and corporate policies to daily situation and concerns
- Ability to present the company’s position persuasively to third parties, including insurance adjusters, attorneys, investigators and state agencies
- Excellent organizational and time management skills
- Self-motivated, able to work well independently
- Experience with claims/risk management information systems
- Ability to learn and adapt to new and innovative software programs
- Ability to maintain strict confidentiality
- Strong PC literacy in Microsoft Office software (Word, Excel, PowerPoint).
- Strong organizational and time management skills.
4. BA in Risk Management and Insurance with 4 years of Experience
- Strong experience obtaining and processing prior authorizations and managing claims through the approval process.
- Strong experience with managing claims appeals
- Experience with the administrative management of an electronic practice management system
- Experience with clearinghouse oversight, including oversight of 837, 835, and 277 files and dashboard management
- Strong typing and data entry skills including 10-key
- Highly experienced and comfortable with the use of software technologies in the execution of duties
- Intermediate knowledge of Microsoft such as Excel (pivot tables), Word, Outlook, and PowerPoint
- Strong communication skills, including active listening and clear articulation
- Strong organizational, problem-solving, prioritization and attention to detail skills.
- Good analytical and negotiation skills to effectively review and administer claims process.
- Working knowledge in risk management and claims processing and experience with claims database administration (i.e., Riskkonnect).
- Understanding of state laws and regulations affecting insurance practices and familiarity with medical terminology, legal processes, general insurance policy coverage, claims investigation techniques, and medical and legal aspects of claims.
- Proficiency in MS Office (Word and Excel).
5. BS in Economics with 3 years of Experience
- In-depth knowledge of workers' compensation claim handling process and management of that process
- Strong data analysis skills and ability to utilize data to drive results.
- Knowledge of state workers’ compensation claim handling rules & regulations
- Strong Microsoft Excel experience
- Excellent oral and written communication skills
- Strong organizational skills
- Strong customer service skills
- Ability to work in a team environment
- Ability to handle multiple task experience in the insurance industry
- Experience using claims systems and correspondence systems
- Computer literate, including effective working skills in MS Office and basic system skills
- Able to deal with people sensitively, tactfully, diplomatically, and professionally at all times.s and deadlines
Relevant Information