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The Job Description of a Claims Specialist

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When an individual files a claim with an insurance company, claims specialists get the ball rolling for financial resolution. Specialists process claims and negotiate settlements relating to automobile, life, home, health and business insurance. Their specific duties vary with the type of insurance, but managing client accounts before, during and after a claim is filed is the primary responsibility.

General Duties

When an insurance claim is filed, a claims specialist logs the client information, verifies coverage and determines allowable benefits or compensation. This process might involve field visits, interviews or research to determine the validity of the claim. Specialists follow up with clients and insurers to resolve issues and discuss reasons for reduced or unpaid claims. Claims specialists must also compile reports and communicate regularly with supervisors and managers regarding the status of claims. Because insurances regulations change, claims specialists must stay up-to-date on local, state and federal laws that affect how they do their jobs.

Skills and Knowledge

Claims specialist must be accurate in their duties. They must treat clients fairly and equitably, but also make sure claims are legitimate and reasonable. To make this happen, claims specialists must know company policies and procedures inside and out. They must know the details of claims verification, payment processing, dispute resolution and fraud detection. Because insurance is a service-oriented business, claims specialists need interpersonal and communication skills to serve customers in a tactful and diplomatic manner. Written communication skills are also important, as is basic math and the ability to use computers.

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Education

A high school diploma or equivalent can help you get your foot in the door as an entry-level claims specialist. Many employers prefer hiring individuals with a bachelor’s degree in a related field, such as business or accounting. A combination of education and experience may be considered in lieu of a degree. Some employers and state governments require claims specialists to become licensed. Specialists must take and pass a state exam to receive a license, but requirements vary from state to state.

Wages and Work Environment

The annual median salary for claims specialists -- including claims adjusters, appraisers, examiners and investigators -- is $59,960, according to Bureau of Labor Statistics 2012 data. Job responsibilities, job location, years of experience and employment industry influence salaries for claim specialists. For the pay they receive, many claims specialist spend the much of their work day in an office environment reviewing information and data. Some specialists travel to client locations to assess and examine damage or loss.

About the Author

Deb Dupree has been an active writer throughout her career in the corporate world and in public service since 1982. She has written numerous corporate and educational documents including project reports, procedures and employee training programs. She has a Bachelor of Science in chemical engineering from the University of Tennessee.

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