Claims Resolution Clerk Overview

As a Claims Resolution Clerk, you play an essential role in the insurance and financial sectors by managing and resolving claims. Your key responsibilities involve:

  • Claims Processing: You review and validate incoming claims, ensuring that all necessary information and documentation are present and accurate.
  • Communication: It is your responsibility to interact with policyholders, insurance agents, and medical providers to gather additional information or clarify any inconsistencies in claims.
  • Data Entry and Management: You are tasked with entering claims information into databases and managing existing claims records, ensuring compliance with organizational and regulatory standards.

  • Resolution and Follow-Up: Your role includes investigating disputes or discrepancies in claims, assessing additional documentation, and working towards a resolution to achieve timely settlements.

    The accuracy and efficiency with which you handle claims are vital for customer satisfaction and organizational credibility. Your work also helps prevent fraud and ensures compliance with various regulations, making you a key player in maintaining industry integrity. By ensuring that claims are processed smoothly, you contribute to the overall success of the organization and support policyholders during potentially stressful times.

Claims Resolution Clerk Salary

Annual Median: $42,120
Hourly Median: $20.25

Data sourced from Career One Stop, provided by the BLS Occupational Employment and Wage Statistics wage estimates.

Required Education and Training To Become a Claims Resolution Clerk

To become a Claims Resolution Clerk, you typically need specific educational qualifications and training. Consider the following degree programs that can provide a solid foundation for this career path:

  • Administrative Assistant and Secretarial Science: This program focuses on developing essential office skills, including communication, organization, and proficiency in office software, which are beneficial for managing claims and documentation.

  • Auditing: Studying auditing equips you with an understanding of financial records and compliance, which can be advantageous when dealing with claims related to financial transactions.

  • Business Administration: A degree in business administration provides a comprehensive overview of business operations, including management principles and organizational behavior. This knowledge can be useful for resolving claims efficiently and understanding business policies.

  • Customer Service Management: Courses in customer service management emphasize the skills needed to handle consumer interactions effectively. This training can prepare you to address claims directly and manage customer relations.

  • Legal Administrative Assistant and Secretary: This program offers specialized training in legal terminology, documentation, and procedures, which can be invaluable for working with claims that involve legal aspects or require familiarity with regulatory compliance.

Pursuing one of these educational paths can provide you with the foundational knowledge and competencies necessary for a successful career as a Claims Resolution Clerk.

Best Schools to become a Claims Resolution Clerk in U.S. 2024

#1DuPage County

DeVry University-Illinois

Naperville, IL

In-State Tuition:$14,392
Out-of-State Tuition:$14,392
Admission Rate:43%
Graduation Rate:43%
Total Enrollment:26,384
#2San Diego County

Ashford University

San Diego, CA

In-State Tuition:$12,240
Out-of-State Tuition:$12,240
Admission Rate:N/A
Graduation Rate:10%
Total Enrollment:34,190
#3Miami-Dade County

Miami Dade College

Miami, FL

In-State Tuition:$1,987
Out-of-State Tuition:$7,947
Admission Rate:N/A
Graduation Rate:45%
Total Enrollment:47,245
#4Brevard County

Eastern Florida State College

Melbourne, FL

In-State Tuition:$2,048
Out-of-State Tuition:$8,399
Admission Rate:N/A
Graduation Rate:51%
Total Enrollment:13,114
#5Sheboygan County

Lakeland University

Plymouth, WI

In-State Tuition:$30,400
Out-of-State Tuition:$30,400
Admission Rate:100%
Graduation Rate:52%
Total Enrollment:2,406
#6Lynchburg City

Virginia University of Lynchburg

Lynchburg, VA

In-State Tuition:$8,200
Out-of-State Tuition:$8,200
Admission Rate:N/A
Graduation Rate:87%
Total Enrollment:837
Claims Resolution Clerk Job Description:
  • Compose letters or electronic correspondence in reply to requests for merchandise, damage claims, credit and other information, delinquent accounts, incorrect billings, or unsatisfactory services.
  • Duties may include gathering data to formulate reply and preparing correspondence.

Required Skills and Competencies To Become a Claims Resolution Clerk

  • Attention to Detail: You must possess a keen eye for detail to accurately review claims, identify discrepancies, and ensure all information is correct.

  • Analytical Skills: You need the ability to analyze claims data, understand complex documents, and discern patterns or issues that require resolution.

  • Communication Skills: Effective written and verbal communication is essential for explaining decisions clearly to claimants and collaborating with other departments.

  • Customer Service Orientation: You should be adept at maintaining a positive attitude when interacting with clients, demonstrating empathy and understanding their concerns.

  • Organizational Skills: Strong organizational abilities help you manage multiple claims efficiently, prioritize tasks, and meet deadlines.

  • Problem-Solving Skills: You must be capable of identifying problems quickly and developing effective solutions to resolve claims in a timely manner.

  • Technical Proficiency: Familiarity with claims management software and databases is important for accessing and inputting information accurately.

  • Negotiation Skills: You may need to negotiate settlements or resolve disputes, which requires tact and diplomacy.

  • Regulatory Knowledge: Understanding relevant laws and regulations related to claims processing ensures compliance and informs decision-making.

  • Team Collaboration: You should be able to work collaboratively with colleagues across various departments to facilitate the claims resolution process.

Job Duties for Claims Resolution Clerks

  • Gather records pertinent to specific problems, review them for completeness and accuracy, and attach records to correspondence as necessary.

  • Maintain files and control records to show correspondence activities.

  • Read incoming correspondence to ascertain nature of writers' concerns and to determine disposition of correspondence.

Technologies and Skills Used by Claims Resolution Clerks

Medical software

  • Electronic health record EHR software
  • Healthcare common procedure coding system HCPCS

Presentation software

  • Microsoft PowerPoint

Spreadsheet software

  • Microsoft Excel

Basic Skills

  • Listening to others, not interrupting, and asking good questions
  • Writing things for co-workers or customers

Problem Solving

  • Noticing a problem and figuring out the best way to solve it

Current Job Market and Opportunites for a Claims Resolution Clerk

The job market for Claims Resolution Clerks is characterized by steady demand and moderate growth potential, particularly as industries that rely on claims processing continue to evolve. Here are key aspects of the current landscape:

  • Demand for Claims Resolution Clerks:

    • Organizations across sectors, including insurance, healthcare, and finance, require skilled clerks to manage the complexities of claims processing.
    • The ongoing need for effective claims handling, especially in response to an increasing number of claims due to factors like health reforms and natural disasters, sustains a steady demand for professionals in this role.

  • Growth Potential:

    • The Bureau of Labor Statistics (BLS) projects steady job growth in the administrative support field, under which Claims Resolution Clerks fall.
    • Opportunities may expand as companies seek to improve operational efficiency and reduce costs, leading to more streamlined processes and therefore increased hiring.

  • Geographical Hotspots:

    • Urban areas with concentrations of healthcare facilities, insurance companies, and legal firms often exhibit a higher demand for Claims Resolution Clerks. Examples include:
      • Major metropolitan areas such as New York City, Los Angeles, and Chicago.
      • States with a robust insurance market, such as Florida and Texas, also provide numerous opportunities.
    • The emergence of remote work has further expanded opportunities nationwide, allowing clerks to work for companies located outside their immediate geographical area.

  • Industry Trends:

    • Companies are increasingly adopting automation and digital tools for claims processing, which can shift the role of Claims Resolution Clerks towards managing and resolving disputes rather than clerical tasks.
    • As industries continue to grapple with regulatory changes and evolving customer expectations, there will be a persistent demand for skilled clerks who can navigate complex claims environments effectively.

In this dynamic job market, the opportunities for Claims Resolution Clerks are influenced by a mix of technological advancements and regional economic conditions, paving the way for a fulfilling career in a critical administrative sector.

Top Related Careers to Claims Resolution Clerk 2024

Customer Service Correspondence Specialist
Billing Inquiry Clerk
Administrative Correspondence Coordinator
Customer Relations Correspondent

Additional Resources To Help You Become a Claims Resolution Clerk

  • National Association of Independent Insurance Adjusters (NAIIA)
    Website: naiia.com
    This organization represents independent adjusters and can provide valuable insights into industry standards and best practices.

  • American Academy of Professional Coders (AAPC)
    Website: aapc.com
    AAPC offers resources on coding, billing, and compliance, which are important areas related to claims processing.

  • Insurance Information Institute (III)
    Website: iii.org
    A reputable source for statistics, news, and resources about various insurance topics, including claims processing.

  • National Association of Insurance Commissioners (NAIC)
    Website: naic.org
    This organization provides regulatory information and resources that pertain to the insurance industry and claims handling.

  • Bureau of Labor Statistics (BLS) - Claims Adjusters, Appraisers, Examiners, and Investigators
    Website: bls.gov/ooh/business/claims-adjusters-appraisers-examiners-and-investigators.htm
    The BLS offers detailed job outlook data, salary information, and descriptions of the skills needed for claims resolution clerks.

  • ProInsuranceTraining.com
    Website: proinsurancetraining.com
    This site provides various courses and training materials for those in the insurance and claims processing fields.

  • Insurance Claims Institute (ICI)
    Website: insuranceclaims.org
    A resource for continuing education and certifications relevant to claims processing, including updates on industry trends.

  • LinkedIn Learning
    Website: linkedin.com/learning
    Explore a wide range of courses on claims management, customer service, and conflict resolution, beneficial for building your professional skill set.

  • Coursera
    Website: coursera.org
    Provides access to courses from universities related to finance, insurance principles, and customer service that are useful for claims resolution clerks.

  • Meetup.com - Insurance Networking Groups
    Website: meetup.com
    Find local insurance professional groups to connect with others in the field and share knowledge and resources.

Utilizing these resources will assist you in enhancing your knowledge and skills within the field of claims resolution.

FAQs About Becoming a Claims Resolution Clerk

  • What is the role of a Claims Resolution Clerk?
    As a Claims Resolution Clerk, you are responsible for processing and resolving claims submitted by policyholders. This includes verifying information, communicating with clients and insurance adjusters, and ensuring that claims are processed efficiently and accurately.

  • What qualifications do I need to become a Claims Resolution Clerk?
    Typically, a high school diploma or equivalent is required, though some employers may prefer an associate degree or coursework in business or insurance. Familiarity with insurance policies, strong communication skills, and attention to detail are also important.

  • What are the key skills needed for this position?
    Essential skills include:

    • Analytical thinking to assess and resolve claims.
    • Strong communication for effectively interacting with clients and colleagues.
    • Organizational skills to manage multiple claims simultaneously.
    • Proficiency in computer software commonly used in insurance claims processing.

  • What is the typical work environment for a Claims Resolution Clerk?
    You will likely work in an office setting, which may be within an insurance company, law firm, or related organization. The job can be office-based or remote, depending on the employer's policies.

  • What is the average salary for a Claims Resolution Clerk?
    Your salary may vary based on factors such as location, experience, and the employer. As of 2023, the average salary in the U.S. typically ranges from $35,000 to $55,000 per year.

  • Are there opportunities for advancement in this career?
    Yes, there are various paths for advancement. With experience, you could move into supervisory roles, specialize in certain types of claims (like medical or property claims), or transition into related fields such as underwriting or risk management.

  • What kind of training can I expect?
    On-the-job training is common, where you will learn specific procedures and policies relevant to your employer. Some companies may offer workshops or training sessions to enhance your skills.

  • What are the most common challenges faced in this role?
    Common challenges include handling high volumes of claims, managing difficult conversations with clients, and navigating complex insurance policies. Staying organized and having strong problem-solving skills can help mitigate these challenges.

  • Is certification required for this job?
    Certification is usually not mandatory, but obtaining relevant certifications from recognized organizations, such as the Insurance Institute of America (IIA), can enhance your credentials and job prospects.

  • How can I prepare for a career as a Claims Resolution Clerk?
    You can prepare by gaining experience in customer service or administrative roles, learning about insurance basics, and improving your skills in data entry and software applications commonly used in claims processing. Networking with professionals in the insurance industry can also provide valuable insights.