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Key Responsibilities and Required Skills for Insurance Clerk

💰 $30,000 - $50,000

InsuranceAdministrationClericalCustomer Service

🎯 Role Definition

The Insurance Clerk supports insurance operations by accurately processing claims and policy transactions, maintaining insured records, responding to client and provider inquiries, and ensuring compliance with company procedures and regulatory standards. This role requires strong attention to detail, familiarity with insurance terminology and systems, excellent customer service, and the ability to prioritize high volumes of documentation and data work to keep claims and policies moving through the lifecycle efficiently.

Primary keywords: Insurance Clerk, claims processing, policy administration, insurance documentation, data entry, customer service, compliance, billing reconciliation.

📈 Career Progression

Typical Career Path

Entry Point From:

  • Customer Service Representative (insurance or related)
  • Administrative Assistant / Office Clerk
  • Data Entry Specialist

Advancement To:

  • Senior Insurance Clerk / Lead Clerk
  • Claims Examiner / Claims Specialist
  • Policy Administrator
  • Team Supervisor / Claims Supervisor
  • Underwriting Assistant → Underwriter (with additional training)

Lateral Moves:

  • Billing Clerk / Accounts Receivable
  • Records Coordinator / Document Control Specialist
  • Customer Service Specialist (Insurance)
  • Loss Control or Risk Management Support

Core Responsibilities

Primary Functions

  • Accurately review, code, and enter incoming claims, policy changes, endorsements, cancellations, and reinstatements into the policy administration system while meeting daily productivity and quality standards.
  • Validate policyholder and claimant information by verifying coverage dates, policy limits, beneficiary designations, and endorsement history to ensure correct adjudication.
  • Process payments, refunds, premium adjustments, and billing transactions, reconcile daily receipts, and prepare payment batches for posting to the general ledger or billing system.
  • Examine incoming correspondence, medical records, invoices, and supporting documentation; attach, index, and file documents in electronic document management systems for claims and policy files.
  • Communicate professionally with policyholders, claimants, medical providers, brokers/agents, and internal adjusters via phone, email, and written correspondence to gather information and resolve routine inquiries.
  • Open and assign new claims to the appropriate claims adjuster or handle first-level triage; capture initial loss details, claimant demographics, and incident information into the claims management system.
  • Follow established procedures to process authorizations, referrals, and verifications of benefits for health or specialty lines, ensuring timely approvals and accurate recordkeeping.
  • Investigate and resolve discrepancies in claim forms, bills, or policy data by coordinating with third parties (providers, vendors, agents) and escalating complex issues to supervisors or adjusters.
  • Prepare and submit required regulatory filings, notices, and disclosure documents to comply with state insurance department requirements and company audit policies.
  • Monitor and track claims and policy deadlines (statute of limitations, notice periods, premium due dates) and proactively notify responsible parties to prevent lapses or late filings.
  • Reconcile remittance advices, EOBs (explanations of benefits), and carrier payments, posting payments to the correct account and initiating follow-up on short pays and denials.
  • Maintain an organized physical and electronic filing system, perform periodic file audits, purge inactive files according to retention schedules, and support document discovery requests.
  • Generate routine and ad-hoc reports (claims status, aging, payment activity, policy endorsements) for managers and adjusters using Excel and reporting tools, ensuring data accuracy for decision-making.
  • Apply company policies and coverage language to process routine claims and policy servicing tasks; flag potential coverage issues and refer complex interpretations to underwriting or legal teams.
  • Follow HIPAA, privacy, and confidentiality protocols when handling medical and personal information; ensure secure transfer and storage of protected data.
  • Support the claims team during peak volumes by performing overflow processing, mailroom duties, and batch scanning with consistent accuracy and speed.
  • Enter and maintain agent and broker commission/information records; liaise with the broker services team to correct commission-related discrepancies.
  • Assist with the coordination of subrogation, salvage, and recovery paperwork by preparing demand letters, claim packages, and forwarding documentation to recovery specialists.
  • Record and process cancellations, reinstatements, lapses, and renewals; notify policyholders and agents of status changes and provide documentation as required.
  • Participate in quality assurance checks and contribute to root-cause analysis of frequent data or documentation errors to improve processes and reduce rework.
  • Prepare claim and policy files for internal and external audits, provide requested documentation, and implement corrective actions from audit findings.
  • Maintain up-to-date knowledge of product offerings, policy forms, and standard endorsements to provide accurate clerical support across multiple insurance lines.

Secondary Functions

  • Assist with process improvement initiatives by documenting workflows, suggesting efficiency gains, and piloting small automation or digital intake solutions.
  • Support ad-hoc reporting requests, data validation exercises, and month-end reconciliation tasks for the claims and policy administration teams.
  • Coordinate with IT and vendor partners to report system defects, test fixes for policy or claims system changes, and validate data migrations.
  • Train and mentor new clerical hires on systems, procedures, quality standards, and best practices to achieve consistent onboarding outcomes.
  • Help prepare materials for external audits, litigation holds, and regulatory examinations by compiling file inventories and retrievals.
  • Participate in cross-functional meetings with underwriting, billing, and customer service to resolve recurring client issues and improve end-to-end customer experience.

Required Skills & Competencies

Hard Skills (Technical)

  • Claims processing and adjudication experience in property & casualty, health, or life insurance environments.
  • Policy administration proficiency, including processing endorsements, cancellations, renewals, and reinstatements.
  • Familiarity with common insurance systems (examples: Guidewire ClaimCenter/PolicyCenter, Duck Creek, AMS360, Vertafore, or other policy/claims systems).
  • Strong data entry speed and accuracy; experience using electronic document management systems (EDMS) and OCR/scanning workflows.
  • Microsoft Office proficiency, especially Excel for reconciliation, pivot tables, and reporting.
  • Knowledge of billing and payment posting processes, including EDI payments and reconciling remittances/EOBs.
  • Basic accounting knowledge related to premiums, receivables, and general ledger posting.
  • Understanding of insurance terminology, policy language, coverages, exclusions, and endorsements.
  • Regulatory and compliance awareness (HIPAA, state insurance regulations, privacy, and records retention).
  • Experience with CRM or customer service platforms and case management ticketing systems.

Soft Skills

  • Exceptional attention to detail and high accuracy in data and document handling.
  • Clear verbal and written communication; ability to explain routine coverage or billing items to non-technical customers.
  • Strong organizational skills and ability to prioritize multiple tasks in a fast-paced environment.
  • Customer service orientation with patience and professionalism when interacting with upset or confused claimants and policyholders.
  • Problem-solving mindset with the ability to escalate appropriately and follow through on assigned tasks.
  • Reliability and strong work ethic, including meeting deadlines and production targets.
  • Team player mentality with collaborative approach to cross-functional work.
  • Discretion and integrity in handling confidential and sensitive information.
  • Adaptability to changing procedures, system updates, and compliance requirements.
  • Initiative to identify process gaps and propose practical improvements.

Education & Experience

Educational Background

Minimum Education:

  • High school diploma or GED.

Preferred Education:

  • Associate's degree or Bachelor's degree in Business Administration, Insurance, Finance, or a related field.
  • Industry certifications (e.g., AINS, CPCU coursework, or state-specific licenses) considered a plus.

Relevant Fields of Study:

  • Business Administration
  • Insurance / Risk Management
  • Finance or Accounting
  • Records Management / Information Administration
  • Health Information Management (for medical claims roles)

Experience Requirements

Typical Experience Range:

  • 0–3 years for entry-level Insurance Clerk roles; 2–5 years preferred for mid-level positions.

Preferred:

  • 1–3 years direct experience processing insurance claims or policy administration in an insurance carrier, TPA (third-party administrator), broker agency, or medical billing environment.
  • Demonstrated experience with insurance systems, EDI payments, and electronic document workflows.
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