INSURANCE CLAIMS SPECIALIST SKILLS, EXPERIENCES, AND JOB REQUIREMENTS
Published: Oct 03, 2025 - The Insurance Claims Specialist applies prior experience in claims adjustment, brokerage, and legal research to analyze cases, assess risks, and make timely decisions that support organizational goals. This role requires strong communication in English and Spanish, effective collaboration, and the ability to manage complex conversations with accuracy and attention to detail. The specialist also demonstrates advanced proficiency in Microsoft Office 365, critical thinking skills, and the capacity to perform effectively under pressure.
Essential Hard and Soft Skills for an Insurance Claims Specialist Resume
- Claim Valuation
- Site Inspection
- Inventory Management
- Authorization Management
- Denial Analysis
- Claim Processing
- Policy Review
- Database Management
- Claims Investigation
- Documentation Accuracy
- Time Management
- Collaboration
- Communication
- Problem Solving
- Research
- Customer Assistance
- Follow Up
- Confidentiality Practice
- Accuracy Maintenance
- Inquiry Handling
Summary of Insurance Claims Specialist Knowledge and Qualifications on Resume
1. BA in Business Administration with 7 years of Experience
- Experience in computer skills, including Outlook and Excel
- Experience in the display of positive energy, strong verbal and written communication skills
- Experience in healthcare administration or practice support role
- Working experience in insurance claims adjusting, Trust and Safety, Fraud, Risk Management, or a related role
- Experience working with or for a gig or sharing economy company
- Experience handling high-priority escalations and working promptly to provide resolutions
- Ability to manage claims independently in most circumstances, with minimal supervision
- Prior background/experience in the Property claims industry
- Able to provide an adequate workspace, free of noise
- Must have strong communication skills
- Demonstrated ability to adapt to change and new technology
2. BS in Finance with 5 years of Experience
- Must have a Certified Professional Coder (CPC) from the American Academy of Professional Coders (AAPC)
- Experience working with personal computers and software packages (i.e., the Microsoft Office Suite, including Word, Excel, etc.)
- Excellent written, verbal, and interpersonal communication skills
- Comprehensive understanding of the Health Care Financing Administration (HCFA) billing practices, and health care issues affecting billing and reimbursement
- Ability to interact effectively with a wide range of cultural, ethnic, racial, and socioeconomic backgrounds
- Completion of college-level coursework with a focus in Accounting, Business, in a Healthcare-focused major, or other related field
- Experience working with third-party payers
- Experience with professional coding in a hospital/physician’s billing office
- Strong analytical skills and adept problem-solving abilities
- Working experience in a Computerized billing system
3. BA in Economics with 8 years of Experience
- Comprehensive understanding of a range of services, processes, procedures, systems and concepts within each area of specialty (insurance total loss, probate)
- Able to perform multiple and/or diverse tasks that are highly complex, requiring specialized expertise
- Ability to organize, prioritize and manage a large workload for optimum efficiency
- Demonstrated attention to detail and the ability to prioritize workload to meet department objectives efficiently
- Proven ability to work cooperatively with peers and managers to bring accounts to a favorable resolution while building a positive work environment
- Detailed knowledge of contractual and security agreements
- Knowledge of specific regulations in all provinces in which GMF does business relating to insurance claims and probate
- Understands and complies with regulatory requirements in all jurisdictions
- Work-related experience in the auto insurance industry
- Proficiency in MS Office
- Previous experience in a call centre environment
- Understanding the knowledge of auto leasing insurance requirements
- Working knowledge of all provincial and federal legislation/regulations as it relates to auto leasing insurance claims and probate processes
- Working knowledge of the probate process
4. BA in Legal Studies with 6 years of Experience
- Strong interpersonal, verbal, and written communication skills
- Excellent organizational and time management skills
- Ability to multitask and adapt to change in a fast-paced environment
- Proficient with technology
- Must be able to receive a high volume of inbound calls as well as make outbound calls
- Must have excellent typing skills and be able to document the information while receiving an inbound call
- Experience within the revenue cycle
- Prior experience in denials management
- Proven knowledge of insurance regulations and policies, payment policies/guidelines
- Ability to communicate and work with payers to get claims resolved and paid accurately
- Working experience in Insurance claims
- Strong customer service and office administrative skills
5. BS in Information Systems with 5 years of Experience
- Strong customer service and office administrative skills
- Experience within the revenue cycle
- Previous denials management experience
- Working experience in Accounts Receivable (AR)
- Deep understanding of medical claims
- Working experience in Insurance Verifications
- Proven knowledge of insurance regulations and policies, payment policies/guidelines
- Ability to communicate and work with payers to get claims resolved and paid accurately
- Proven knowledge of explanation of benefits (EOBs)
- Strong research, writing, and communication skills
- Skill and experience with computer systems and programs, including electronic management systems
6. BS in Criminal Justice with 6 years of Experience
- Prior experience working as an insurance claims adjuster or insurance broker
- Prior experience working with attorneys conducting legal research and writing equivalent to that expected of an experienced paralegal
- Able to analyze situations to determine the importance, urgency and risks, and make clear and timely decisions and in the best interests of the organization
- Able to set priorities, develop a work schedule, monitor progress towards goals, and track details/data/information/activities
- Excellent oral and written communication, both in English and Spanish
- Able to work cooperatively and effectively with others to set goals, resolve problems, and make decisions that enhance organizational effectiveness
- Advanced domain of Microsoft Office 365 programs (Word, Excel, and Outlook)
- Strong communication skills and the ability to handle difficult conversations
- Excellent critical thinking and decision-making skills
- High attention to detail
- Ability to work under pressure