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Automation Squad

Role

AI for Insurance Claims Processors

Robert MacKelfresh

By Robert MacKelfresh

Founder, Automation Squad

Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives.

Insurance Claims and Policy Processing Clerks · O*NET 43-9041.00 · Job Zone 2 · sourced from the U.S. Department of Labor occupation database

Automation coverage

12 of 27tools on this list have an AI solution available today

Counted by matching the tools this occupation is documented as using against a corpus of 226,452 AI products, MCP servers, skills and connectors. Where a tool has no match, we say so rather than inventing one.

AI you can use for this job

19 matched to the tools insurance claims and policy processing clerks use. Showing 19.

The tools this job actually uses

27 documented for this occupation. Showing 27, hot technologies first. A filled dot means an AI solution exists for it.

  • Microsoft Accesshot
  • Microsoft Excelhot
  • Microsoft Office softwarehot
  • Microsoft Outlookhot
  • Microsoft PowerPointhot
  • Microsoft Windowshot
  • Microsoft Wordhot
  • Account management software
  • Alpha Software Alpha Five
  • Automated information system software
  • Billing software
  • Claim processing system software
  • Database software
  • GroupMe
  • Healthcare common procedure coding system HCPCS
  • IBM Check Processing Control System CPSC
  • IBM Lotus Notes
  • Insurance rating software
  • InSystems Calligo Enterprise
  • Medical condition coding software
  • Medical procedure coding software
  • MicroFocus GroupWise
  • Microsoft Internet Explorer
  • Policy issuance system software
  • St. Paul Travelers e-CARMA
  • Web browser software
  • Xactware Xactimate

What this job involves

25 documented tasks, most important first. Showing 24.

  1. Prepare insurance claim forms or related documents, and review them for completeness.
  2. Pay small claims.
  3. Calculate amount of claim.
  4. Post or attach information to claim file.
  5. Transmit claims for payment or further investigation.
  6. Contact insured or other involved persons to obtain missing information.
  7. Review insurance policy to determine coverage.
  8. Process and record new insurance policies and claims.
  9. Process, prepare, and submit business or government forms, such as submitting applications for coverage to insurance carriers.
  10. Organize or work with detailed office or warehouse records, using computers to enter, access, search or retrieve data.
  11. Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
  12. Correspond with insured or agent to obtain information or to inform them of account status or changes.
  13. Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.
  14. Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.
  15. Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
  16. Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.
  17. Collect initial premiums and issue receipts.
  18. Interview clients and take their calls to provide customer service and obtain information on claims.
  19. Obtain computer printout of policy cancellations, or retrieve cancellation cards from file.
  20. Compose business correspondence for supervisors, managers, and professionals.
  21. Notify insurance agent and accounting department of policy cancellation.
  22. Calculate premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards.
  23. Enter insurance- and claims-related information into database systems.
  24. Modify, update, or process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
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