What Is a Claims Specialist?

July 17, 2024

Are you thinking of what career path to choose or considering a career change? If you are a good negotiator and have organizational and problem-solving skills, you may be suitable for a claims specialist job. This article will explain what is a claims specialist, and what this job description involves.

 

What Is a Claims Specialist?

Claim specialists provide administrative and customer relations support for processing insurance claims. They play a crucial role in all phases of the claims process, from the beginning until the final payout.

More precisely, claims specialists gather information, review all documents, and check data if necessary. In case they find issues, these specialists work quickly to resolve them. They serve as liaisons, helping to communicate between the insured party and the insurer, service provider, or other relevant parties.

 

Source: shutterstock.com / Photo Contributor: fizkes

 

 

Role and Responsibilities

Daily responsibilities

If you are looking for jobs for claims specialists, you need to know what to expect in a job advertisement which includes the roles and responsibilities a claims specialist must have. Such responsibilities include:

Types of claims handled

 

Skills and Qualifications

Essential skills

To become a successful professional, first, you need to possess and acquire several claims specialist skills that will help you do your job efficiently. You need to be attentive to details to analyze claims.

Claims specialists should possess analytical and problem-solving skills to analyze and resolve claims. Besides these skills, it is indispensable to possess strong communication abilities. As a claim specialist, you must interact with different people and pass information clearly and professionally.

Finally, having organizational and time management skills is important to handle multiple claims and deadlines.

 

Claims Specialist Essential Skills
Source: shutterstock.com / Photo Contributor: fizkes

 

Educational requirements

To become a claims specialist, you usually need a bachelor’s degree in business, finance, law, or healthcare. Yet, some employers may accept a high school diploma or an associate’s degree with relevant work experience.

Moreover, based on the type and jurisdiction of the claims, you may need a license or certificate from a certain organization. For example, you may need the Certified Claims Professional (CCP) certificate, which shows that you understand the basic principles of managing insurance claims, competency in practical application, and a commitment to this profession.

Another example is if you work with insurance claims, you may need to pass an exam and have a continuing education program to maintain your license.

Experience and training

Prior experience is important because it helps you understand industry practices, such as regulations and customer expectations. Besides, if you have worked with claims before, you will be more accurate and efficient in processing them.

Another advantage is having experience with customer support. That way, you will be more prepared to handle and resolve issues, which leads to better customer satisfaction. But that is not the only factor that leads to better results. On-the-job training is also important. It involves initial training, mentorship, and role-specific training, such as property, auto, or health insurance claims.

Continuous education is vital in maintaining and refreshing knowledge, ensuring it remains current with new developments. This ongoing learning includes diverse opportunities such as certifications, workshops, seminars, and professional development courses.

 

Common Challenges

As a claim specialist, you may face some important challenges and stressful situations.

 

Common Challenges
Source: shutterstock.com / Photo Contributor: NONGASIMO

 

Find the Best Claims Specialist Jobs With Afni

What is a claims specialist? A claim specialist deals with insurance claims in different industries, such as health or car insurance. Claim specialists report and process these claims and are included in the administrative processing of the claims. They gather information, review all documents, check data, and resolve issues if needed.

If you comply with the claim specialist requirements and possess the skills, you might enjoy following this career path. If you believe job hunting can be a hard experience, we assure you that with companies like Afni, finding your next job as a claims specialist would be quick, easy, and fun.

Author

is the Recruitment Marketing Manager for Afni and brings a wealth of knowledge and tips for job seekers. She holds a bachelor's degree in public relations and marketing from Mount Saint Vincent University as well as a masters degree in digital marketing and advertising from Liberty University.

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