Description
Interact with policyholders, claimants, and providers to take and service claims, provide standard information on coverage and status, and resolve routine issues or complaints. Document all contacts, process basic updates or payments within authority, and escalate complex matters to adjusters or specialized teams. Excludes roles primarily performing claims adjusting, sales, repair, or technical support.
- • Resolve routine claim or billing issues by correcting data, reissuing payments, or initiating simple adjustments within authority.
- • Explain deductibles, limits, and payment processes; update payee, address, and EFT information.
- • Schedule inspections, appraisals, or appointments with adjusters or service providers.
- • Contact customers to communicate coverage decisions, payment details, or additional information needed.
- • Escalate disputes, suspected fraud, or complex grievances to adjusters, SIU, or designated departments.
- • Compare invoices, estimates, or treatment/repair charges with claim records and submit for approval or reconciliation.
- • Recommend improvements to claim communications, forms, or processes based on recurring customer feedback.
- • Communicate via phone, email, or chat and document all interactions in compliance with privacy and regulatory requirements.
- • Maintain detailed records of claim-related contacts, documents, and actions taken.
- • Take first notice of loss (FNOL) and create or update claim files in the system.
- • Answer inquiries and provide claim status, timelines, and next steps.
- • Review policy terms at a high level to address basic coverage questions; route complex determinations to adjusters.
- • Gather and verify required documentation (loss details, photos, invoices, police or medical reports).
- • Verify that promised updates, payments, or corrections were completed in the claim file.
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Marketing & Sales
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Source
Tasks & skills:
O*NET occupational data (work activities, skills, knowledge).
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This site includes information from O*NET by the U.S. Department of Labor, Employment and Training Administration (USDOL/ETA), used under the CC BY 4.0 license. Career Clutch has modified some of this information for student readability. USDOL/ETA has not approved, endorsed, or tested these modifications. O*NET® is a trademark of USDOL/ETA.
Last reviewed: Jan 2026
