General Insurance Associate
Competency-based
ONET: 43-9041.01
20
Skills
148h
Related instructions
Classroom instruction topics
- Professionalism
- Employability Skills
- Health Insurance Fundamentals
- Introduction to Healthcare Financing
- Customer Service Skills
- Getting Information
- Communicating
- Business Ethics
- Analyzing the Healthcare Value Chain
- Population Health & Critical Outcomes Report Assessment (CORA certification)
- Marketing and Promotion: Positioning Benefits Advisors in the Healthcare Market
- Speech (Communications 2)
- Health Benefit Proposal Design, Evaluation and Implementation
- Time Management, Organization Skills and Project Management 101
- Analyzing and Managing Expensive Medical Procedures Using Data
- Health Informatics & Technology Changes
- Managing Organization Change in Benefits Administration
- DIFS Test Prep
On-the-job training
- Facilitate claims processing for policyholders
- Gather and verify information from policyholders and affected parties
- Consult policy documentation and determine the extent of coverage for claims
- Adjust or deny claims in consideration of deductibles and policy terms
- Prepare written reports to document findings about the claim, incident, and related records
- Approve and issue payments when charges are deemed allowable and acceptable
- Support underwriting activities and risk management
- In interactions with new or existing customers, guide them through the underwriting process
- Document facts or information needed to assess policy coverage and risk
- Refer cases to underwriters when a change in policy or circumstances is determined to fall outside of usual conditions, but may still be insurable
- Detect fraud and report to special investigators
- Communicate well with customers and team members
- Establish and maintain courteous client relationships with prospective and existing policyholders
- Educate customers about policies, including availability, eligibility, policy changes, transfers, claim processing, billing, and decisions
- Communicate clearly with colleagues to support decision-making and the overall efforts of the team and organization
- Conduct operational and processing tasks with order, accuracy, and diligence
- Input and maintain detailed and up-to-date claim files with data and analysis of coverage, damages, incident reports, correspondence, and related records
- Analyze submitted claims, bills, reports, and estimates for accuracy
- Handle data within the prescribed sequence and execute prompt processing of claims, documentation, and payments
- Comply with internal and external standards and requirements for reporting
- Review all material representation to ensure accuracy of any necessary measurement data
- Ensure compliance with standards and policies
- Comply with company's standards and customer service policies
- Stay up to date with company's policy rules and any implemented changes
- Take training from employer to stay current on legal and regulatory changes in the industry
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Made in the USA.