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Claims Specialist Job Description Template

Job Description Template

Claims Specialist Job Description Template

September 7, 2022

Claims Specialist Job Description Template

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What is a Claims Specialist?

Claims Specialists, also known as Claims Examiners or Claims Consultants, work in the insurance industry.

A Claims Specialist processes, reviews, and analyzes claim that people filed against their insurance companies.

Their job is to establish and decide whether they should be paid out or not.

Additionally, Claims Specialists negotiate claims settlements and verify insurance coverage.

They also conduct site and damage inspections to gather more information and make the right decision.

In the end, Claims Specialists are responsible for resolving clients’ inquiries and updating them on claim statuses.

Related Job Titles for Claims Specialist

The Top Claims Specialist Skills

Skill Why it's important
Communication Effective communication is essential for Claims Specialists, as they interact and collaborate with clients, insurance companies, and other parties. They need to convey and explain complex and important claims details in an understandable way to their clients. Claims Specialists must also have great written communication skills.
Analytical Mind Having an analytical mind means being able to accurately analyze data and information and come to logical conclusions. Since Claims Specialists review a great number of medical records, insurance policies, and other documentation, analytical skills are vastly important for them. This skill helps them determine whether a claim is valid or not.
Attention to Detail Detail-oriented Claims Specialists can notice small mistakes or errors in documentation and make corrections. It is of huge importance that all records, claims, and other documentation is accurate. Attention to detail helps Claims Specialists verify the clients’ information and process claims precisely.
Problem-Solving Claims Specialists’ job involves dealing with people who experienced a material loss or damage and are in problematic situations because of that. Their responsibility is to assess the situation timely, inspect the area or accident if necessary and determine the best and most beneficial solution for the client.
Organization The ability to stay organized helps Claims Specialists keep track of their numerous responsibilities and cases. They should maintain their surroundings organized because that way it would be easier and quicker for them to find paperwork or files they need for a specific claim or case.

Claims Specialist Job Description Template (Free)

We are looking for a highly-analytical Claims Specialist to join our insurance company. You will be in charge of reviewing clients’ claims and insurance policies and determining if a client should be paid out or not. Moreover, you will be responsible for a deeper investigation of insurance claims to ensure their accuracy and prevent fraud. You will also negotiate claims terms and conditions with insurance companies and prepare claims settlements.

You will be required to visit accident sites to assess the level of damage and ask questions to gather the necessary information. The perfect candidate for this position should have in-depth knowledge of the latest policies and guidelines in the insurance industry. Ultimately, the skills we are looking for are excellent communication, problem-solving, attention to detail, organization, and an analytical mind.

Claims Specialist Duties & Responsibilities:

  • Review insurance policies, medical records, and other documentation to establish coverage for claims
  • Analyze and investigate insurance claims to discover or prevent fraud
  • Prepare reports and statements by gathering and summarizing information
  • Resolve claims by approving or declining documentation
  • Establish compensation settlements
  • Conduct detailed site and damage inspection
  • Negotiate claims terms and conditions with insurance companies
  • Calculate commissions and other fees owed by policyholders
  • Maintain quality customer service by providing information to clients about coverage options, payments plans, etc
  • Handle and resolve clients’ inquiries and concerns
  • Ensure compliance with the companies policies and guidelines and state and federal insurance regulations
  • Collaborate with attorneys to prepare claims settlements and receive legal support

Claims Specialist Requirements:

  • High school diploma or a GED
  • A Bachelor’s degree in finance, business, accounting, or a similar discipline
  • Previous working experience in similar positions
  • Strong knowledge of current insurance state and federal laws, policies, and regulations
  • Outstanding communication and negotiation skills
  • Excellent organization
  • Strong analytical mind
  • Superb attention to detail

Accounting Specialist Interview Questrions

Sample Interview Questions for a Claims Specialist

Once you gather up all the received applications, you can use these sample interview questions for Claims Specialist. The following questions may assist you in determining which candidate is the most qualified for the position.

  1. Could you tell us something about yourself?
  2. What are your three most prominent traits?
  3. Do you have a favorite sport?
Human Resources
  1. What do you consider the most important skill for a Claims Specialist?
  2. What industries have you worked in so far?
  3. Could you tell us more about your major in college?
  1. How well do you handle stressful situations?
  2. Have you ever made a mistake while investigating a claim? What happened then?
  3. How do you stay organized when having a lot to do on a particular day?
Technical Skills and Knowledge
  1. In what instances do you deny a claim?
  2. How do you determine if a claim is convenient for compensation?
  3. How familiar are you with insurance software and complex insurance forms?

What are the Educational Requirements for a Claims Specialist?

The majority of companies and employers look for candidates with a Bachelor’s degree in business, accounting, finance, or a similar discipline.

Other employers consider a high school diploma or a GED is enough.

A huge advantage for candidates in the insurance industry is previous working experience.

Those who are familiar with the latest insurance policies and regulations and handling complex paperwork and situations are more likely to expand their hiring opportunities.

How Much to Pay a Claims Specialist when Hiring

Claims Specialists earn between $23,500 and $52,500 per year.

Their median annual salary is around $40,455.

Hourly rates go from $12 to $25.

The median hourly rate is $19.

Percentile 10% 25% 50%
75% 90%
Hourly Wage $12 $16 $19 $22 $25
Annual Wage $23,500 $33,000 $40,455 $45,500 $52,500

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Frequently Asked Questions about Claims Specialist


Where do Claims Specialists work?

Claims Specialists can work in auto, home, health, and business insurance companies.

They can also be hired by self-insured organizations and government agencies.

Who do Claims Specialists work with?

Claims Specialists work directly with a client who experiences an accident or damage.

They can also collaborate with Claims Adjusters and attorneys, and negotiate with insurance agencies.

How to become a successful Claims Specialist?

In order to become successful Claims Specialists, candidates must obtain a Bachelor’s degree in accounting, business, or finance.

They also need to work on their knowledge and experience and develop skills necessary for this position, such as communication, negotiation, problem-solving, organization, and attention to detail.

How much do Claims Specialists earn per year?

Claims Specialists earn between $23,500 and $52,500 annually.

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