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Insurance Claims and Policy Processing Clerks

SOC 43-9041.00Job Zone 2 · Some Preparationv.26.05

Context coveredThis framework covers insurance claims and policy processing work performed in office and administrative environments, spanning document preparation, policy review, data management, claimant communication, and team leadership across a Job Zone 2 career trajectory.

Sources:O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.SkillsCrosswalkSkillsCrosswalk — O*NET enrichment + adjacency index. Opens in new tab.
Emerging
Entry / Apprentice
  1. Insurance claim forms — complete and review for basic errors under direct supervisor guidance in a clerical office environment.
  2. Claim file records — post and attach supporting documents following established procedures in an entry-level processing role.
  3. Claims data — enter and retrieve information using database software under close supervision in an administrative setting.
  4. Insurance policy terms — read and identify basic coverage provisions with supervisor support in a standard office environment.
  5. Claim amounts — calculate straightforward totals using provided formulas and basic arithmetic tools in a processing unit.
  6. Completed claims — transmit to designated queues or payment departments following step-by-step workflow instructions.
  7. Missing claimant information — contact insured persons by phone or email using scripted prompts in a supervised office role.
  8. New policy records — process and log into tracking systems following a defined checklist in an administrative support role.
  9. Office filing systems — organize physical and digital claim documents according to established naming and sorting conventions.
  10. Email and messaging software — use to communicate routine claim status updates under direct instruction in an office setting.
Developing
Mid-level / Established
  1. Insurance claim forms — prepare, review, and correct for completeness with minimal oversight across routine claim types.
  2. Claim payment amounts — calculate accurately using standard rate tables and billing software in a moderate-volume processing environment.
  3. Policy coverage details — review independently to determine applicability to standard submitted claims in a daily processing workflow.
  4. Claim files — update and maintain using document management software while meeting established turnaround time requirements.
  5. Insured parties and third parties — contact proactively to gather missing or clarifying information for pending claims without supervisor prompting.
  6. New insurance policies — process and record into company systems consistently and accurately across multiple policy types.
  7. Claims database — search and retrieve relevant records to support claim reviews and resolve routine discrepancies in an office environment.
  8. Time-sensitive claim batches — prioritize and manage workload using scheduling tools to meet daily processing targets.
  9. Routine claim irregularities — identify and escalate appropriately using judgment developed through on-the-job experience.
  10. Spreadsheet software — use to organize and track claim status data across an assigned portfolio of accounts.
Proficient
Senior / Expert IC
  1. Complex insurance claim forms — prepare and review autonomously, resolving non-routine completeness issues across diverse claim categories.
  2. High-value or disputed claim amounts — calculate with precision by applying policy terms, coverage limits, and applicable deductions independently.
  3. Insurance policy language — interpret across multiple coverage lines to make accurate and consistent coverage determinations without escalation.
  4. Multi-source claim information — synthesize from claimants, medical software, and financial records to build comprehensive claim files.
  5. Outstanding or problematic claims — transmit with detailed documentation and case notes to support downstream payment or investigation decisions.
  6. Difficult or sensitive claimants — engage with clarity, active listening, and service orientation to resolve information gaps efficiently.
  7. End-to-end policy and claim workflows — manage across the full processing lifecycle, identifying and correcting system or procedural errors.
  8. Data integrity issues in claims databases — detect through routine monitoring and correct using query software to maintain accurate records.
  9. Emerging claim patterns or recurring errors — identify through critical analysis and communicate findings to supervisors with supporting evidence.
  10. Cross-functional claim inquiries — coordinate responses between agents, adjusters, and billing teams using email and messaging tools effectively.
Advanced
Lead / Principal / Executive
  1. Claims processing standards and procedures — develop and refine for the team to improve accuracy, efficiency, and regulatory compliance.
  2. New clerks and processing staff — mentor and train on claim form preparation, policy review, and data entry best practices.
  3. Workflow bottlenecks and error trends — analyze using database and spreadsheet tools to drive systemic improvements across the processing unit.
  4. Coverage determination guidelines — establish and communicate to ensure consistent policy interpretation across all clerks in the department.
  5. Technology and software tools — evaluate and champion adoption of new document management, billing, or database systems to modernize operations.
  6. Quality control processes — design and oversee to maintain high standards of claim file completeness and data accuracy department-wide.
  7. Escalated or complex claims — provide authoritative review and final disposition guidance that resolves cases beyond the scope of peers.
  8. Interdepartmental communication protocols — standardize to ensure timely and accurate transmission of claims between processing, legal, and payment teams.
  9. Performance metrics and productivity targets — set, monitor, and report on for the claims processing team to departmental leadership.
  10. Compliance and audit requirements — lead preparation efforts by ensuring all records, processes, and documentation meet regulatory and organizational standards.

AI-at-Work Competency Framework

Sources:Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab.Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab.WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab.
Subscriber feature

Authoritative source data identified for 998 occupations

How a worker at each mastery level uses, directs, and evaluates AI tools in this occupation. Each statement cites its evidence inline; click a citation chip to verify the source.

Emerging
  1. AI-assisted form scanning — uses an AI tool to highlight incomplete or inconsistent fields on claim forms before submission, then manually confirms each flagged item against source documents Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  2. Claim calculation support — enters loss data into an AI-assisted calculator to produce a first-pass claim amount, then cross-checks the figure against policy schedules by hand Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
Developing
  1. Missing-information drafting — directs an AI assistant to generate outreach messages to insureds or third parties when required data is absent from a file, editing the draft for tone and accuracy before sending Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  2. Document attachment workflow — uses AI-powered document routing to post and tag supporting materials to the correct claim file, verifying that categorization matches policy terms Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  3. Time-load prioritization — applies an AI queue-management tool to rank open claims by urgency and deadline, adjusting the sequence based on personal knowledge of case complexity Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab..
Proficient
  1. End-to-end claim preparation — orchestrates AI assistance across form preparation, completeness review, and transmittal steps, achieving substantial processing time savings while retaining responsibility for accuracy and compliance Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  2. Reading-comprehension augmentation — leverages AI summarization of lengthy policy language to isolate coverage provisions relevant to a specific claim, then applies independent judgment to confirm applicability Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  3. Collaborative AI triage — works alongside AI tools that flag claims for further investigation versus routine payment, evaluating each recommendation against case facts before acting Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
  4. Quality-control loop — reviews AI-generated claim calculations and coverage determinations for errors, correcting outputs that misread policy exclusions or claimant statements Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab..
Advanced
  1. AI output governance — establishes local standards for when AI-generated claim decisions require human escalation, trains less-experienced clerks on those thresholds, and monitors error rates to refine the criteria Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  2. Process redesign leadership — identifies which claim-processing subtasks yield the highest time savings under AI collaboration, redesigns the team workflow around those gains, and documents the revised procedures for compliance review Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
  3. Edge-case adjudication — handles claims where AI tools flag ambiguous policy language or conflicting information, applying critical thinking and social perceptiveness to reach a defensible determination that AI cannot autonomously produce Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab. WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab..
Evidence pack
AEI usage
Task observations: 381
Augment share: 38.1%
Time saved: 89.9%
AI autonomy: 2.67
SAFI positioning
Top skill: Reading Comprehension
Score: 45.5 / 100
Quadrant: Q2_ai_augmented
precision: exact
WEF cluster
Human-Technology Interaction
human_technology_interaction
Sources:Anthropic Economic IndexAnthropic Economic Index — release_2026_03_24. Opens in new tab.WEF Skills TaxonomyWEF Skills Taxonomy 2021 — Building a Common Language for Skills at Work. Opens in new tab.Jadhav & Danve, 2026Skill Automation Feasibility Index — Jadhav & Danve, 2026 (arXiv:2604.06906). Opens in new tab.

Pathsmith Durable Skills Framework

Sources:Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Subscriber feature

Ten durable-skill domains mapped to four proficiency/role levels for each occupation. Each statement is aligned to the Pathsmith taxonomy, derived from trusted grounding data and mapped to occupation-specific O*NET tasks and skills.

1Communication12 statements
Emerging
  1. Claim form language — reads and interprets basic insurance terminology on standard claim forms to identify required fields Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Policyholder contact — asks scripted clarifying questions when contacting insured parties to gather missing claim information O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Internal status updates — relays claim processing status to supervisors using basic office communication tools Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Missing information requests — composes clear written correspondence to insured parties and third parties requesting specific documentation needed to complete claim files Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Policy explanation — explains coverage terms and claim procedures to policyholders in plain language during phone or written interactions Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Cross-department coordination — communicates claim discrepancies or escalation needs to adjusters and underwriters with accurate detail O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Multi-channel claim communication — manages policyholder inquiries across phone, email, and written correspondence, tailoring tone and complexity to the audience while maintaining accuracy Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Coverage determination communication — articulates specific policy provisions and exclusions to claimants in a manner that is factually precise and professionally empathetic Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Regulatory documentation language — drafts claim-related documents and transmittal records using compliant, unambiguous language suitable for legal and audit review O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Communication standards development — establishes templates and scripts for claim intake and follow-up correspondence that improve consistency and reduce information gaps across the processing team Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Complex claim narrative — constructs thorough written summaries of contested or high-value claims that synthesize policy language, claimant statements, and supporting documents for investigative or legal audiences Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Peer communication coaching — mentors junior clerks on professional written and verbal communication standards specific to claims and policy processing workflows Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
2Leadership10 statements
Emerging
  1. Task ownership — takes personal responsibility for completing assigned claim forms and policy records accurately within established deadlines Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Procedure adherence — follows supervisor guidance on claims processing priorities and escalates issues promptly when workload conflicts arise Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Workflow self-direction — organizes daily claim processing tasks independently, sequencing work to meet volume and turnaround expectations without supervisor prompting Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. New clerk guidance — demonstrates standard claim entry and file organization procedures to newly onboarded colleagues during initial training periods Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. Processing queue leadership — takes initiative to identify and resolve bottlenecks in the claims queue, redistributing or prioritizing files to maintain team throughput Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Quality ownership — assumes accountability for the accuracy of submitted claim batches, conducting self-review and flagging errors before transmittal to adjusters or payment systems Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Team coordination — coordinates daily task assignments among clerks when a supervisor is unavailable, ensuring coverage and continuity of claim processing operations Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Process improvement leadership — leads cross-functional initiatives to revise claim intake or policy recording procedures, securing buy-in from adjusters, underwriters, and compliance staff Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Mentorship and development — coaches developing clerks on advanced policy interpretation and claim calculation techniques, building team capability and reducing error rates Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Operational resilience — guides the processing team through high-volume surges or system outages by reallocating tasks and maintaining service levels under pressure Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
3Metacognition9 statements
Emerging
  1. Error self-identification — recognizes personal gaps in understanding policy terminology or claim calculation rules and seeks clarification before submitting work Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Learning pace awareness — identifies which types of claim forms or coverage categories require additional review time and adjusts personal task scheduling accordingly Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Processing pattern recognition — reflects on recurring errors in claim entries and adjusts personal verification routines to reduce repeat mistakes Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Knowledge gap targeting — identifies specific insurance product lines or software functions where skill is limited and pursues targeted learning resources to address gaps Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. Workflow self-monitoring — evaluates personal claim processing accuracy and speed against team benchmarks, adjusting strategies when performance deviates from targets Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Cognitive load management — recognizes when simultaneous handling of complex and routine claims creates attention risk and restructures the workday to protect accuracy Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Feedback integration — systematically applies corrections from claim audits or supervisor reviews to modify personal documentation habits and reduce future errors Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Strategic skill mapping — conducts periodic self-assessment of competency across all claim types and policy products, creating personal development plans aligned with departmental needs Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Meta-process reflection — analyzes team-wide error patterns by examining collective claim processing behaviors and proposes systemic procedural adjustments informed by that analysis Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
4Critical Thinking11 statements
Emerging
  1. Coverage identification — reads insurance policy documents to locate the specific provisions relevant to a submitted claim before initiating processing Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Completeness check — compares submitted claim forms against required field checklists to identify missing or inconsistent information O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Developing
  1. Claim amount verification — cross-references submitted damage or loss figures against policy limits, deductibles, and applicable schedules to validate calculated claim amounts Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Discrepancy detection — identifies contradictions between policyholder-provided information and policy records, flagging inconsistencies for adjuster review Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Coverage applicability analysis — evaluates whether a reported incident falls within the scope of the applicable policy by examining dates, conditions, and exclusion clauses O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Multi-document claim analysis — synthesizes information across claim forms, police reports, medical records, and policy documents to assess completeness and accuracy before transmittal Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Routing decision-making — determines whether a claim should be approved for routine payment, returned for additional information, or escalated for investigation based on documented evidence Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Assumption testing — questions whether claimant-reported circumstances are consistent with policy terms, applying logical scrutiny rather than accepting submissions at face value Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Complex coverage reasoning — independently interprets ambiguous or layered policy language to resolve coverage questions on non-standard claims without requiring adjuster intervention Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Systemic error analysis — identifies patterns of invalid claims or data entry errors across large file volumes, recommending procedural safeguards to prevent recurrence Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Precedent application — draws on prior claim outcomes and policy interpretations to support consistent and defensible processing decisions on edge-case submissions Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
5Collaboration10 statements
Emerging
  1. Team file sharing — shares claim files and supporting documents with adjusters and underwriters using established office systems, following handoff protocols accurately Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Peer support — assists colleagues with locating policy records or navigating claims software during high-volume processing periods Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Cross-functional coordination — works with adjusters, legal staff, and medical reviewers to gather information needed to finalize pending claims within service timeframes Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Shared workload management — coordinates with fellow clerks to balance claim intake and processing responsibilities during peak periods or staff absences Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Investigative team participation — contributes organized, accurate claim documentation to multi-department investigations of potentially fraudulent or disputed claims Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Vendor and third-party coordination — collaborates with healthcare providers, repair facilities, and legal representatives to obtain records and resolve information gaps in active claim files O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Process alignment — aligns personal claim processing practices with team-wide quality standards through regular peer review and shared feedback sessions Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Inter-departmental initiative leadership — coordinates multi-team efforts to streamline the handoff of complex claims between processing, adjusting, and legal departments Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Collaborative procedure design — partners with supervisors and quality assurance staff to co-develop claim processing checklists and workflows that improve team accuracy and efficiency Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Conflict navigation — mediates disagreements between internal departments or external parties regarding claim documentation requirements, reaching workable solutions that keep claims moving Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
6Character11 statements
Emerging
  1. Data confidentiality — handles policyholder personal and financial information according to privacy protocols and avoids unauthorized disclosure Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Accurate reporting — records claim details truthfully without omission or alteration, even when information is unfavorable or unclear Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Procedural integrity — follows established claim processing rules consistently, resisting shortcuts that could compromise accuracy or compliance Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Professional accountability — acknowledges and corrects personal data entry errors promptly, notifying supervisors when mistakes affect transmitted claims Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Impartial documentation — records claimant information objectively, applying consistent standards regardless of the complexity or perceived merit of the claim Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. Regulatory compliance ownership — ensures all claim forms and policy records meet applicable legal and company standards, treating compliance as a personal professional responsibility rather than an external requirement Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Ethical escalation — identifies and reports suspected fraudulent claims or internal processing irregularities through appropriate channels without delay Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Consistent professionalism — maintains respectful, equitable treatment of all claimants and colleagues across all interactions, including high-stress or adversarial situations Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Ethics modeling — demonstrates and articulates the ethical standards expected in claims processing to newer team members, reinforcing a culture of integrity across the unit Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Compliance advocacy — proactively identifies regulatory changes affecting claim processing procedures and advocates for timely procedural updates to maintain organizational compliance Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Trust building — cultivates a reputation for reliability and fairness with policyholders, third parties, and internal partners that strengthens the department's professional standing Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
7Creativity9 statements
Emerging
  1. Problem workaround — identifies alternative ways to retrieve incomplete claim information when standard contact methods are unsuccessful Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Form adaptation — modifies standard claim documentation approaches to accommodate non-standard loss scenarios while staying within procedural guidelines Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Process shortcut identification — proposes minor workflow adjustments that reduce redundant data entry steps without compromising accuracy or compliance Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Communication reframing — develops alternative ways to explain claim status or coverage denials to claimants who have not understood standard explanations Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. Template innovation — designs or refines internal tracking tools, checklists, or reference guides that improve claim processing consistency and reduce error rates Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Cross-product problem solving — applies processing approaches from one insurance product line creatively to resolve unusual documentation challenges in a different product line Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Claimant engagement strategy — develops personalized follow-up approaches for unresponsive claimants, combining timing, channel, and message adjustments to obtain required documentation Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Exceeding
  1. Workflow redesign — conceives and pilots redesigned claim intake or data entry workflows that measurably improve team throughput and reduce processing errors Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Knowledge resource creation — develops original training materials, quick-reference guides, or decision trees that equip clerks to handle novel claim scenarios more independently Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
8Growth Mindset10 statements
Emerging
  1. Policy learning initiative — proactively reviews unfamiliar insurance product documentation to build knowledge needed to process new claim types accurately Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Error acceptance — receives correction on claim processing mistakes without defensiveness and applies feedback immediately to subsequent work Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Skill expansion — volunteers to process claim types outside current specialization to broaden product knowledge and processing versatility Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Feedback pursuit — actively solicits quality review feedback from supervisors and adjusters to identify and address personal processing weaknesses Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Applying
  1. System change adaptation — approaches updates to claims management software or processing procedures as learning opportunities, quickly achieving functional proficiency in revised tools Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Performance benchmarking — compares personal claim accuracy and turnaround metrics against team standards and sets specific improvement targets based on identified gaps Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Challenge seeking — takes on high-complexity or high-volume claim assignments as opportunities to develop skill rather than sources of stress Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Continuous improvement modeling — demonstrates sustained commitment to learning by regularly updating personal knowledge of regulatory changes, new insurance products, and evolving processing technologies Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Team growth cultivation — creates an environment in which peer clerks view errors as learning data and seek feedback as a standard part of professional development Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Failure reframing — openly shares lessons from past processing errors with the team to normalize learning from mistakes and improve collective quality Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
9Mindfulness9 statements
Emerging
  1. Attention focusing — directs sustained attention to individual claim fields during data entry to reduce transcription errors caused by distraction Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Stress recognition — notices when processing pressure is affecting personal accuracy and pauses briefly to reset focus before continuing high-stakes data entry Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Interruption management — maintains focus on complex policy reviews or claim calculations despite phone calls and office interruptions by using deliberate attention re-engagement techniques Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Emotional regulation with claimants — manages personal frustration during difficult policyholder interactions, maintaining professional composure throughout the conversation Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Present-task discipline — resists the tendency to rush through claim verification steps under volume pressure, maintaining methodical attention to each document regardless of queue size Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Intentional prioritization — consciously evaluates daily claim priorities at the start of each shift, aligning attention and energy with the most time-sensitive or complex files Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  3. Reactive response management — pauses before responding to ambiguous or contentious claim situations, applying deliberate judgment rather than an automatic reaction Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Team attentiveness modeling — demonstrates and coaches mindful work habits to the processing team, linking present-moment focus practices directly to reduced error rates and improved service quality Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Environmental awareness leadership — identifies workspace or scheduling conditions that systematically degrade team focus and advocates for changes that support sustained accuracy Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
10Fortitude10 statements
Emerging
  1. Volume tolerance — continues processing claims accurately during moderate surges without abandoning quality standards or requiring escalated supervision Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Setback recovery — resumes productive claim processing promptly after receiving error corrections or dealing with difficult claimant interactions Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Developing
  1. Deadline persistence — maintains consistent effort and accuracy through sustained high-volume periods and end-of-period processing deadlines Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. Ambiguity tolerance — continues working on claims with incomplete or conflicting information, taking deliberate steps to resolve uncertainty rather than stalling Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Applying
  1. Adversarial interaction resilience — handles hostile or distressed claimants with measured professionalism, not allowing the emotional intensity of the interaction to compromise processing accuracy or service quality Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  2. System disruption endurance — maintains claim processing continuity during software outages or system transitions by using manual procedures and documented backup protocols Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Sustained accuracy under pressure — preserves data entry and calculation precision across extended high-demand processing periods without deterioration in quality metrics Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Exceeding
  1. Organizational resilience contribution — stabilizes team morale and productivity during prolonged surges, regulatory audits, or operational disruptions through consistent composure and decisive action Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
  2. Courage in escalation — raises concerns about processing irregularities, compliance risks, or systemic errors to leadership even when doing so is organizationally uncomfortable Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab. O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
  3. Long-term persistence modeling — demonstrates sustained high performance and professional commitment across extended difficult periods, setting a standard of endurance that anchors team culture Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.
Sources:Pathsmith Durable SkillsPathsmith Durable Skills Framework — America Succeeds + CompTIA. Opens in new tab.O*NET v30.2O*NET Resource Center — Occupational Information Network, v30.2 (Sept 2025). Opens in new tab.
Show O*NET source anchors50 anchors · skillscrosswalk.com

O*NET enrichment · skillscrosswalk.com

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Source anchors that ground each statement

Related titles
Agency Service Representative (Agency Service Rep) · Auto Claims Rep (Automotive Claims Representative) · Auto Liability Claims Rep (Automotive Liability Claims Representative) · Billing and Insurance Coordinator · Bodily Injury Claims Representative (Bodily Injury Claims Rep) · Cancellation Clerk · Claim Representative (Claims Rep) · Claims Adjudicator · Claims Analyst · Claims Assistant · Claims Associate · Claims Clerk
RAPIDS apprenticeships
—
O*NET skills
Reading ComprehensionTime ManagementSpeakingActive ListeningCritical ThinkingSocial PerceptivenessCoordinationService OrientationWritingJudgment and Decision MakingMonitoringComplex Problem Solving
Knowledge domains
Customer and Personal ServiceAdministrativeEnglish LanguageComputers and Electronics
Abilities
Written ComprehensionOral ComprehensionSpeech RecognitionSpeech ClarityOral ExpressionNear VisionInformation OrderingDeductive ReasoningWritten ExpressionProblem Sensitivity
Work styles
Attention to DetailDependabilityIntegrityCautiousnessCooperationSelf-Control
Technology
Accounting softwareData base user interface and query softwareBilling and invoicing softwareInstant messaging softwareMedical softwareElectronic mail softwareFinancial analysis softwareDocument management softwareSpreadsheet softwareInternet browser software
Tasks · seed anchors for statements
  1. Prepare insurance claim forms or related documents, and review them for completeness.
  2. Calculate amount of claim.
  3. Post or attach information to claim file.
  4. Transmit claims for payment or further investigation.
  5. Contact insured or other involved persons to obtain missing information.
  6. Review insurance policy to determine coverage.
  7. Process and record new insurance policies and claims.
  8. Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
CIP education codes
52.0408

Sources: O*NET v30.2 (CC BY 4.0), SkillsCrosswalk.com, LER.me, Anthropic Economic Index, SAFI (Jadhav & Danve, 2026), WEF Skills Taxonomy 2021, Pathsmith Durable Skills Framework. © 2026 EBSCOed.