Insurance processors, often referred to as insurance claims and policy clerks, complete a wide array of behind-the-scenes duties for an insurance company. Typical tasks include reviewing and screening new insurance applications, processing renewal policies and verifying benefits eligibility on claims filings submitted by providers or covered parties.
Insurance processors are commonly the first people to review new policy applications submitted by insurance agents or individuals. In reviewing the application, the processor confirms the completeness and accuracy of all information provided. Some applications require submission of additional documents that the processor must verify. In some cases, such as with life policies, the processor may contact the applicant to complete a questionnaire used in assessing coverage and benefits.
Insurance companies typically receive a large number of claims on a daily basis from providers and covered parties. These claims seek payout of benefits on behalf of the covered person. The insurance processor typically reviews the claim and compares it to the benefits stated in the insured person's policy. Either alone or as part of a claims review team, the processor makes a decision to pay or deny coverage, or to follow up with a provider for more details.
Much of the work a processor does must be recorded and communicated internally. These steps are often carried out through computer software programs. Uploading of documents, reports and claims is typical. This ensures that internal employees and covered parties can review documents as needed. On small claims, the processor may also go beyond basic review of the policy and actually calculate the payout amounts.
Other Administrative Tasks
Processors also carry out a number of additional administrative tasks that may vary by company. Along with processing new and renewal applications, the processor is typically responsible for recording the changes made to policy terms and conditions, especially upon renewal. The processor is also normally responsible for communicating changes in coverage status, such as a policy cancellation, addition or removal of benefits or reinstatement.