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Claims associate skills for your resume and career

Updated January 8, 2025
4 min read
Claims associate example skills
Below we've compiled a list of the most critical claims associate skills. We ranked the top skills for claims associates based on the percentage of resumes they appeared on. For example, 14.2% of claims associate resumes contained customer service as a skill. Continue reading to find out what skills a claims associate needs to be successful in the workplace.

15 claims associate skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims associates use customer service:
  • Awarded company based certifications in anatomy, medical terminology, claims resolution, customer service, and customer conflict resolution.
  • Delivered superior customer service and satisfaction by initiating prompt contact, setting expectations, and effectively utilizing all available technology.

2. Medical Claims

Here's how claims associates use medical claims:
  • Process incoming medical claims from providers*Responded and acted upon verbal and written requests with thorough follow-up leading to resolution.
  • Reviewed medical claims from different hospitals to determine if services were necessary and payable following Medicare guidelines.

3. Phone Calls

Phone calls are a wireless or wired connection made over a telephone or a mobile phone between two people. Two parties are involved in a phone call, the caller and the receiver. A caller dials the number of the one he wants to call, and the recipient hears a bell or a tune to which he picks up the call. The call establishes a connection between them through which they can communicate. The voice is converted into signals and is transmitted through wired or wireless technology.

Here's how claims associates use phone calls:
  • Responded to priority telephone calls courteously and professionally and maintained appropriate documentation of phone inquiries.
  • Handled title work, dispatched field assignments to adjusters and assisted drive in adjusters with receiving customers and routing telephone calls.

4. Claims Handling

Here's how claims associates use claims handling:
  • Demonstrated a comprehensive understanding of property and casualty claims handling.
  • Obtained the initial loss information and initiated the claims handling process in an inbound contact center.

5. Insurance Claims

Here's how claims associates use insurance claims:
  • Dedicated dual skilled insurance professional with experience in investigating and processing automobile and home insurance claims.
  • Calculated allowable amount, patient responsibility, and provider write-off on Medicare and other insurance claims.

6. Medical Terminology

Here's how claims associates use medical terminology:
  • Directed walk-in assistance for one-on-one interaction with customers while utilizing medical terminology.
  • General knowledge of Current Procedural Terminology (CPT) codes, ICD9 & 10 diagnosis codes and medical terminology.

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7. Inbound Calls

Here's how claims associates use inbound calls:
  • Received inbound calls requesting information on specific claims or general information.
  • Answered inbound calls where I provided quality customer service with a high call volume for State Farm Auto Insurance policy holders.

8. Claims Process

Here's how claims associates use claims process:
  • Reviewed and identified claims processed incorrectly and completed the adjustment/reprocessing actions according to TRICARE guidelines.
  • Provide professional telephone services Data entry of incoming correspondences Correcting claims processed in error

9. Claims Payments

Here's how claims associates use claims payments:
  • Checked claims status and offered detailed explanations reference claims payments or reasons for denial to beneficiaries and providers.
  • Calculate adequate claims payment based on provider contract language, rates and member benefits.

10. Auto Accidents

Here's how claims associates use auto accidents:
  • Investigate auto accidents, determine liability, negotiate and convey claim settlements within authority limits.
  • Conducted thorough investigations to determine liability in auto accidents while maintaining customer relationship.

11. Auto Claims

Auto claims are claims made to insurance companies or firms in cases of accidents, collisions, or damages to determine payments made. Insurance companies hire auto claim adjusters to help inspect, assess, and determine the state of damager on an auto vehicle and the costs that would incur.

Here's how claims associates use auto claims:
  • Receive and review auto claims in team environment by making investigative contact with insureds/claimants involved, determining a liability decision.
  • Investigated and determined liability and coverage as it applies to auto claims and customer-specific policy regulations.

12. Telephone Calls

Telephone calls are a communication means through which a caller is connected to the called party. The call is done through a telecommunications device called a telephone. The caller can use a landline, mobile phone, or satellite phone to make the call.

Here's how claims associates use telephone calls:
  • Answer incoming telephone calls that include answering billing questions, file update questions, and claimants basic questions.
  • Received and placed telephone calls to/from units to correct claims and correspondence relating to court proceedings.

13. State Laws

Here's how claims associates use state laws:
  • Interview involved parties, witnesses, and review damages to establish liability in accordance with State Laws and statutes.
  • Ensured that all claims were processed according to best practices and state laws and followed claims to closure.

14. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how claims associates use outbound calls:
  • Placed outbound calls to TPC to set up the claim and provide adjuster's information.
  • Assist in inbound and outbound calls and mentor new hires in training and processing claims

15. HIPAA

Here's how claims associates use hipaa:
  • Followed HIPAA policy on each and every call.
  • Abided by the laws and regulations associated under HIPAA and patient confidentiality.
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List of claims associate skills to add to your resume

The most important skills for a claims associate resume and required skills for a claims associate to have include:

  • Customer Service
  • Medical Claims
  • Phone Calls
  • Claims Handling
  • Insurance Claims
  • Medical Terminology
  • Inbound Calls
  • Claims Process
  • Claims Payments
  • Auto Accidents
  • Auto Claims
  • Telephone Calls
  • State Laws
  • Outbound Calls
  • HIPAA
  • Communication Channels
  • Telephone Inquiries
  • Liability Decisions
  • Insurance Contracts
  • Insurance Carriers
  • Police Reports
  • Policy Coverage
  • Medicaid
  • Insurance Policies
  • Loss Reports
  • Hazardous Waste
  • Meeting Quality Standards
  • Customer Inquiries
  • Hazardous Materials
  • ICD-9
  • Hazmat
  • Juris
  • Policy Holders
  • Repair Facilities
  • Tricare
  • CPT-4
  • Medical Bills
  • Computer System
  • Arbitration
  • Call Handling
  • Rental Reservations
  • Sales Floor
  • Body Shop
  • Property Damage Claims
  • HCFA
  • Issue Payments
  • Claims Policies
  • Bodily Injury Claims

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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