Insurance Claims and Policy Processing Clerks

Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives.

SOC: 43-9041.00

Common Job Titles

Claims ProcessorClaims Representative (Claims Rep)Claims Technician (Claims Tech)Underwriting Assistant

What You'll Need to Succeed

AI-generated

Key competencies for this occupation at a glance

  • KnowledgeEvaluate insurance claims forms and policy applications for accuracy and completeness using company standards and regulatory requirements, working independently in an office environment.
  • KnowledgeApply insurance policy provisions and claims processing procedures when reviewing policyholder requests and updating existing policies in claims management systems.
  • KnowledgeAnalyze policyholder information and supporting documentation to determine eligibility and compliance with insurance regulations and company guidelines.
  • KnowledgeInterpret medical coding systems and billing procedures when processing healthcare claims using HCPCS and diagnosis coding software.
  • Hands-onOperate claims processing and policy management software systems to document, record, and update policyholder information following established protocols.
  • Hands-onExecute data entry and database updates in insurance management systems using Microsoft Office applications and specialized claim processing software with accuracy under time constraints.
  • MindsetEngage with policyholders to gather information and clarify documentation requirements, demonstrating active listening and service orientation during verbal and written communications.
  • MindsetRespond to policyholder inquiries and concerns regarding claims status and policy modifications, maintaining professionalism and customer focus in high-volume service environments.
  • KnowledgeOrganize multiple claims and policy processing tasks, prioritizing workload to meet processing deadlines and service level agreements.
  • MindsetParticipate in interdepartmental communication and coordination, collaborating with supervisors, insurance representatives, and other clerks to resolve discrepancies and process exceptions.
Wage Data According to the Bureau of Labor Statistics

Annual wage data for Insurance Claims and Policy Processing Clerks (2024)

Estimated Total Employment (U.S.)

229,070

Wage Distribution by Percentile

MetricU.S.
10% of workers earn the following or less$36,900
10% of workers earn the following or more$73,100
Workers on average earn$51,980

+ indicates wage is at or above the BLS reporting cap ($239,200/year)

Skills & Requirements

Key competencies for this occupation, ranked by importance

  • Customer and Personal Service4.2/5
  • Administrative3.9/5
  • English Language3.6/5
  • Computers and Electronics3.0/5
  • Mathematics2.9/5
Tools & Technology

Equipment and software commonly used in this occupation

In-Demand Technology

Frequently requested by employers in job postings

Microsoft AccessMicrosoft ExcelMicrosoft Office softwareMicrosoft OutlookMicrosoft PowerPointMicrosoft WindowsMicrosoft Word

Technology Skills

Account management softwareAlpha Software Alpha FiveAutomated information system softwareBilling softwareClaim processing system softwareDatabase softwareGroupMeHealthcare common procedure coding system HCPCS

Tools & Equipment

10-key calculatorsDesktop computersDictation machinesPersonal computers