What skills does a insurance claims handler need?

A insurance claims handler needs 18 essential skills including insurance law, fraud detection, principles of insurance, actuarial science, claims procedures. Core competencies include .

Will AI replace insurance claims handler jobs?

The AI disruption score for insurance claims handler is 63/100 (high risk). Some tasks may be automated but the role will evolve rather than disappear entirely.

AccountancyBusiness and administration associate professionalsISCO 3315

insurance claims handler

Insurance claims handlers ensure that all insurance claims are handled accurately and that payment for valid claims is made to the policyholders. They use statistical data and reporting to calculate and adjust claims as needed, communicate with and guide policyholders and monitor the progress of a claim.

European Skills Framework

Skills and knowledge areas required for this occupation based on European classification.

Essential (18)

insurance lawinsurance lawThe law and legislation concerning the policies of transferring risks or losses from one party, the insured, to another, the insurer, in exchange for a periodic payment. This includes the regulation o...fraud detectionfraud detectionThe techniques used to identify fraudulous activities.principles of insuranceprinciples of insuranceThe understanding of the principles of insurance, including third party liability, stock and facilities.actuarial scienceactuarial scienceThe rules of applying mathematical and statistical techniques to determine potential or existing risks in various industries, such as finance or insurance.claims proceduresclaims proceduresThe different procedures that are used to formally request a payment for a suffered loss from an insurance company.types of insurancetypes of insuranceThe various types of risk or loss transfer policies that exist and their characteristics, such as health insurance, car insurance or life insurance.manage claim filesmanage claim filesFollow up on the progress of a claim file, keep all parties informed of the status of the file, ensure the customer receives the damages owed, treat any problems or complaints from customers, close th...review insurance processreview insurance processAnalyse all documentation related to a specific insurance case in order to ensure that the application for insurance or the claims process was handled according to guidelines and regulations, that the...synthesise financial informationsynthesise financial informationCollect, revise and put together financial information coming from different sources or departments in order to create a document with unified financial accounts or plans.maintain records of financial transactionsmaintain records of financial transactionsCollate all the financial transactions done in the daily operations of a business and record them in their respective accounts.communicate with beneficiariescommunicate with beneficiariesCommunicate with individuals or organisations who are entitled to receive benefits in the form of funds or other rights in order to obtain information on the procedures, to ensure that beneficiaries r...calculate compensation paymentscalculate compensation paymentsCalculate the amount due by the insurance company in case of a legitimate claim, authorise the financial transfer and address reclamations to other insurance companies if needed.handle incoming insurance claimshandle incoming insurance claimsManage, process and evaluate submitted requests for insurance in case a problem, which is covered under an insurance policy, occurs. The claim may or may not be approved, based on assessment of the ci...apply technical communication skillsapply technical communication skillsExplain technical details to non-technical customers, stakeholders, or any other interested parties in a clear and concise manner.provide financial product informationprovide financial product informationGive the customer or client information about financial products, the financial market, insurances, loans or other types of financial data.classify insurance claimsclassify insurance claimsProcess incoming claims in order to assess their nature and categorise them according to the different types of insurance and claims handling procedures, in order to ensure proper administrative handl...interview insurance claimantsinterview insurance claimantsInterview people who have filed claims with the insurance corporation they are insured with, or through specialised insurance agents or brokers, in order to investigate the claim and the coverage in t...organise a damage assessmentorganise a damage assessmentOrganise a damage assessment by indicating an expert to identify and examine the damage, give information and instructions to experts and follow up on the experts, and write a damage report.

Optional (13)

statisticsstatisticsThe study of statistical theory, methods and practices such as collection, organisation, analysis, interpretation and presentation of data. It deals with all aspects of data including the planning of ...insurance marketinsurance marketThe trends and major driving factors in the insurance market, insurance methodologies and practices, and the identification of the major stakeholders in the insurance sector.trace financial transactionstrace financial transactionsObserve, track and analyse financial transactions made in companies or in banks. Determine the validity of the transaction and check for suspicious or high-risk transactions in order to avoid mismanag...handle customer complaintshandle customer complaintsAdminister complaints and negative feedback from customers in order to address concerns and where applicable provide a quick service recovery.apply statistical analysis techniquesapply statistical analysis techniquesUse models (descriptive or inferential statistics) and techniques (data mining or machine learning) for statistical analysis and ICT tools to analyse data, uncover correlations and forecast trends.decide on insurance applicationsdecide on insurance applicationsAssess applications for an insurance policy, taking into account the risk analyses and client information, in order to deny or approve the application and set in motion the necessary procedures follow...ensure cross-department cooperationensure cross-department cooperationGuarantee communication and cooperation with all the entities and teams in a given organisation, according to the company strategy.manage claims processmanage claims processManage the relation with an insurer related to its obligation to receive, investigate and act on a claim filed by an insured.estimate damageestimate damageEstimate damage in case of accidents or natural disasters.analyse financial riskanalyse financial riskIdentify and analyse risks that could impact an organisation or individual financially, such as credit and market risks, and propose solutions to cover against those risks.assess coverage possibilitiesassess coverage possibilitiesExamine the reports dealing with damage appraisal or injury examination in order to verify whether the insured's damages or injuries are covered in their insurance policies, and if they are to assess ...handle financial disputeshandle financial disputesHandle disputes between individuals or organisations, either public or corporate, which deal with financial matters, accounts, and taxation.handle financial transactionshandle financial transactionsAdminister currencies, financial exchange activities, deposits as well as company and voucher payments. Prepare and manage guest accounts and take payments by cash, credit card and debit card.