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Industries & Professions /
Insurance Policy Processing Workers
Insurance policy processing workers are involved in all aspects of handling insurance applications and settling claims (or requests from policy holders regarding payment). The individual policies are sold by an insurance agent or broker, who sends the policies to processing workers and waits to see whether the company accepts the policy under the terms as written. The agent or the customer may contact policy processing workers many times during the life of a policy for various services. Claims examiners review settled insurance claims to verify that payments have been made according to company procedures and are in line with the information provided in the claim form. These professionals may also need to contact policy processing clerks in the course of reviewing settlements. While a policy processing worker may be assigned a variety of tasks, insurance companies increasingly rely on specialists to perform specific functions.
Claims clerks review insurance claim forms for accuracy and completeness. Frequently, this involves calling or writing the insured party or other people involved to secure missing information. After placing this data in a claims file, the clerk reviews the insurance policy to determine the coverage. Routine claims are transmitted for payment; if further investigation is needed, the clerk informs the claims supervisor.
Claims supervisors not only direct the work of claims clerks but are also responsible for informing policy owners and beneficiaries of the procedures for filing claims. They submit claim liability statements for review by the actuarial department and inform department supervisors of the status of claims.
Reviewers review completed insurance applications to ensure that all questions have been answered by the applicants. They contact insurance agents to inform them of any problems with the applications, and if none are found, reviewers suggest that policies be approved and delivered to policyholders. Reviewers may collect premiums from new policyholders and provide management with updates on new business.
Policy-change clerks compile information on changes in insurance policies, such as a change in beneficiaries, and determine if the proposed changes conform to company policy and state law. Using rate books (or specialized software) and a knowledge of specific types of policies, these clerks calculate new premiums and make appropriate adjustments to accounts. Policy-change clerks may help write a new policy with the client's specified changes or prepare a rider to an existing policy.
Cancellation clerks cancel insurance policies as directed by insurance agents. They compute any refund due and mail any appropriate refund and the cancellation notice to the policyholder. Clerks also notify the bookkeeping department of the cancellation and send a notice to the insurance agent.
Revival clerks approve reinstatement of customers' insurance policies if the reason for the lapse in service, such as an overdue premium, is corrected within a specified time limit. They compare answers given by the policy holder on the reinstatement application with those previously approved by the company and examine company records to see if there are any circumstances that make reinstatement impossible. Revival clerks calculate the irregular premium and the reinstatement penalty due when the reinstatement is approved, type notices of company action (approval or denial of reinstatement), and send this notification to the policyholder.
Insurance checkers verify the accuracy and completeness of insurance company records by comparing the computations on premiums paid and dividends due on individual forms. They then check that information against similar information on other applications. They also verify personal information on applications, such as the name, age, address, and value of property of the policyholder, and they proofread all material concerning insurance coverage before it is sent to policyholders.
Insurance agents must apply to insurance companies in order to represent the companies and sell their policies. Agent-contract clerks evaluate the ability and character of prospective insurance agents and approve or reject their contracts to sell insurance for a company. They review the prospective agent's application for relevant work experience and other qualifications and check the applicant's personal references to see if they meet company standards. Agent-contract clerks correspond with both the prospective agent and company officials to explain their decision to accept or reject individual applications.
Medical-voucher clerks analyze vouchers sent by doctors who have completed medical examinations of insurance applicants and approve payment of these vouchers based on standard rates. These clerks note the doctor's fee on a form and forward the form and the voucher to the insurance company's bookkeeper or other appropriate personnel for further approval and payment.
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