What does a claims support specialist do?
Claims support specialists are the ones who make sure that the right amount of reimbursement rates is paid based on their client's contracts. Their job includes processing medical record requests and reviewing the secondary and tertiary claims for legitimacy. Working with physician and billing office employees to find resolutions for outstanding claim issues is a part of their responsibilities as claim support specialists. They also make follow up calls about unprocessed or denied insurance claims. And having good communication skills and knowledge in healthcare receivables and collections will help them succeed.
Claims support specialist responsibilities
Here are examples of responsibilities from real claims support specialist resumes:
- Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
- Key in DC Medicaid claims for processing.
- Process various compensation benefits applications for veterans in compliance with organizational laws, federal laws, rules and regulations.
- Review and process HMO facility and professional claims determining benefits due in accordance to plan/policy provisions.
Claims support specialist skills and personality traits
We calculated that 21% of Claims Support Specialists are proficient in Data Entry, Dictation, and Claims Support. They’re also known for soft skills such as Computer skills, Customer-service skills, and Listening skills.
We break down the percentage of Claims Support Specialists that have these skills listed on their resume here:
- Data Entry, 21%
Perform clerical duties including data entry, filing paper documents, email and calendar.
- Dictation, 10%
Assist outside appraisers by entering notes via voicemail dictation into intranet system Impact/Claim Net.
- Claims Support, 9%
Provided claims support to the ISS Fraud Investigators who covered the State of New York.
- Loss Reports, 6%
Inputted loss reports and/or claim information via telephone from insureds, claimants and other personnel with customer service as a priority.
- Customer Service, 6%
Provide efficient customer service to policyholder through correspondence, question and answers.
- Office Equipment, 5%
Demonstrated proficiency in the use of numerous technology advancements and other office equipment and machinery.
Most claims support specialists use their skills in "data entry," "dictation," and "claims support" to do their jobs. You can find more detail on essential claims support specialist responsibilities here:
Customer-service skills. Many claims support specialist duties rely on customer-service skills. "representatives help companies retain customers by professionally answering questions and helping to resolve complaints.," so a claims support specialist will need this skill often in their role. This resume example is just one of many ways claims support specialist responsibilities rely on customer-service skills: "support general customer questions when the claims phone line rolls to claims support. "
Listening skills. Another skill that relates to the job responsibilities of claims support specialists is listening skills. This skill is critical to many everyday claims support specialist duties, as "representatives must listen carefully to ensure that they understand customers in order to assist them." This example from a resume shows how this skill is used: "communicated regularly with workers' applicants and medical professionals via telephone calls, emails, and letters. "
Patience. For certain claims support specialist responsibilities to be completed, the job requires competence in "patience." The day-to-day duties of a claims support specialist rely on this skill, as "representatives should be patient and polite, especially when interacting with dissatisfied customers." For example, this snippet was taken directly from a resume about how this skill applies to what claims support specialists do: "provide technical support with patience and clear instruction to make caller feel at ease. "
Problem-solving skills. Another common skill required for claims support specialist responsibilities is "problem-solving skills." This skill comes up in the duties of claims support specialists all the time, as "representatives must determine solutions to customers’ problems." An excerpt from a real claims support specialist resume shows how this skill is central to what a claims support specialist does: "resolved escalated calls from irate patients and employees who had had claims unsettled through initial contact with customer service representatives. "
Interpersonal skills. Another skill commonly found on claims support specialist job descriptions is "interpersonal skills." It can come up quite often in claims support specialist duties, since "representatives should be able to create positive interactions with customers." Here's an example from a resume of how this skill fits into day-to-day claims support specialist responsibilities: "displayed courtesy and strong interpersonal skills with all customer interactions. "
The three companies that hire the most claims support specialists are:
- GEICO42 claims support specialists jobs
- Indianapolis, IN13 claims support specialists jobs
- Erie Insurance12 claims support specialists jobs
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Compare different claims support specialists
Claims support specialist vs. Claims clerk
Claims clerks review the forms and documents for insurance claims to check for missing information and attachments. The data they obtain is entered into their database for safekeeping and quick retrieval. They should know the answers to their clients' questions about the regulations, policies, and procedures covered by their insurance policy. These clerks prepare documents that their agents use to present to their clients. When working for this position, a person must have the ability to communicate well and be familiar with computer applications.
While similarities exist, there are also some differences between claims support specialists and claims clerk. For instance, claims support specialist responsibilities require skills such as "dictation," "claims support," "loss reports," and "phone calls." Whereas a claims clerk is skilled in "clerical support," "shipping receiving," "claims adjusters," and "usps." This is part of what separates the two careers.
The education levels that claims clerks earn slightly differ from claims support specialists. In particular, claims clerks are 0.4% more likely to graduate with a Master's Degree than a claims support specialist. Additionally, they're 0.5% more likely to earn a Doctoral Degree.Claims support specialist vs. Claims service representative
Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim. Also, they determine whether it is worth arranging a settlement and make sure all settlement claims are managed quickly. In addition to evaluating accidents and claims, they renew customer policies based on their history. Qualifications for the job include a firm knowledge of overall company policy, computer literacy, and excellent customer service.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that claims support specialist responsibilities requires skills like "data entry," "dictation," "claims support," and "loss reports." But a claims service representative might use other skills in their typical duties, such as, "policy coverage," "claims process," "auto accidents," and "body shop."
On average, claims service representatives earn a lower salary than claims support specialists. Some industries support higher salaries in each profession. Interestingly enough, claims service representatives earn the most pay in the government industry with an average salary of $38,986. Whereas claims support specialists have higher pay in the insurance industry, with an average salary of $38,452.In general, claims service representatives achieve similar levels of education than claims support specialists. They're 2.0% more likely to obtain a Master's Degree while being 0.5% more likely to earn a Doctoral Degree.Claims support specialist vs. Claims coordinator
Claims coordinators are professionals who are responsible for coordinating activities that are related to handling and processing insurance claims for an organization. These coordinators must serve as liaison officer between the organization, insurance provider, and policyholders to communicate the status and eligibility for coverage for all relevant claims. They need to ensure that billing requirements are met by reviewing insurance claims. Claims coordinators must also answer all the inquiries of their clients while making recommendations to resolve any claim issues.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a claims support specialist is likely to be skilled in "dictation," "claims support," "loss reports," and "office equipment," while a typical claims coordinator is skilled in "patients," "excellent interpersonal," "cms," and "appeals."
Claims coordinators make a very good living in the finance industry with an average annual salary of $41,216. On the other hand, claims support specialists are paid the highest salary in the insurance industry, with average annual pay of $38,452.When it comes to education, claims coordinators tend to earn similar degree levels compared to claims support specialists. In fact, they're 3.6% more likely to earn a Master's Degree, and 1.4% more likely to graduate with a Doctoral Degree.Claims support specialist vs. Support clerk
A support clerk is primarily in charge of performing administrative support tasks in an office, making the daily workflow easier. Their responsibilities typically include preparing and processing documentation, answering and forwarding calls, handling correspondence, disseminating and organizing files, and running errands as needed. They may also update databases, maintaining records of all transactions. Furthermore, as a support clerk, it is essential to maintain an active communication line with staff, coordinating to ensure efficient and smooth workplace operations.
Types of claims support specialist
Updated January 8, 2025
