Insurance Claims Outsourcing to the Philippines

Claims processing is a large unit in insurance operations (second only to the sales unit) involving review, investigation, adjustment and remittance of an insurance claim.

In some companies, full-cycle claims processing may not be done by a single person. For example, review and investigation may be assigned to junior processors, then adjustment and remittance assigned to senior processors. For this reason, claims processors work best in teams, reporting to an experienced team leader for advice and escalation.

Claims processing skills and experience

Many of the skills a candidate needs to be a good claims processor are transferable from other customer service and contact center roles.

The most important skills for claims processors are:

• Excellent English communication skills (both speaking and writing)

• Previous claims processing experience, or strong customer service experience in another field

• Excellent attention to detail
• Compassion for customers, while also adhering to company policies.

In hiring medical or health insurance claims processors, most employers prefer candidates who are already familiar with medical and billing terms, because this speeds up the onboarding process.

Whereas for car and life insurance claims processors, there are fewer technical terms, so no previous industry experience is necessary. During their introductory training, new employees are quick to come up to speed with industry terms and processes. Claims processors are categorized by level, for all types of insurance claims:

• Junior – has 1-2 years of work experience as a claims processor
• Intermediate – 2-3 years of work experience as a claims processor
• Senior – 3+ years work of experience as a claims processor.

Claims processing tools

Most insurance companies develop their own tools and software for claims processing. The tools usually include a secure database or customer relationship management (CRM) software for storing their customers’ sensitive data such as personal information, health information and credit history.

While each company has their own unique system, interface, and data entry conventions, the skills for using such systems are transferable, so you’ll find that new employees pick up the differences with just a small amount of training.