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Claims Associate information

What does a claims associate do?

A claims associate handles claims for an insurance company. As a claims associate, your job duties may include reviewing a customer’s insurance coverage and interviewing those who have filed a claim. Your job is to ensure that a claim is processed correctly, so the customer receives the financial payout to which they are entitled. In this career, you usually work in an office, but you may need to travel to gather information about the claim. There are positions in every insurance industry so that you may work in anything from auto to life insurance. This position requires excellent research and interpersonal skills, and experience in customer service is a plus. Additional qualifications may include an associate degree.

What does a claims associate do?

A Claims Associate is responsible for reviewing, processing, and managing insurance claims submitted by policyholders. Their duties include verifying information, evaluating the validity of claims, and ensuring all necessary documentation is complete. They often communicate with customers, healthcare providers, or other parties to gather additional information and resolve any issues. Claims Associates play a crucial role in ensuring claims are processed accurately and efficiently according to company policies and regulatory guidelines.

What are the key skills and qualifications needed to thrive as a claims associate?

To thrive as a Claims Associate, you need a solid understanding of insurance policies, attention to detail, and basic analytical skills, usually supported by a high school diploma or equivalent. Familiarity with claims management systems, CRM software, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Strong communication, problem-solving, and customer service abilities set top performers apart. These skills are essential for accurately processing claims, ensuring compliance, and providing a positive experience for clients and policyholders.

What are some common challenges a claims associate may face, and how can they effectively handle them?

Claims Associates often encounter challenges such as managing a high volume of claims, navigating complex policy details, and communicating with clients who may be experiencing stress or frustration. Effectively handling these situations requires strong organizational skills, attention to detail, and clear, empathetic communication. Many Claims Associates find success by proactively prioritizing tasks, seeking guidance from senior team members when needed, and utilizing available technology to streamline documentation and follow-ups.

What is the difference between Claims Associate vs Claims Examiner?

AspectClaims AssociateClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may prefer insurance-related certificationsHigh school diploma; insurance certifications like CPCU or similar beneficial
Work EnvironmentOffice setting, interacting with customers and internal teamsOffice setting, reviewing claims and documentation
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, adjusting departments
Common Search & ComparisonClaims Associate vs Claims Examiner

The main difference between a Claims Associate and a Claims Examiner lies in their responsibilities. Claims Associates typically handle initial customer interactions and basic claim processing, while Claims Examiners review and assess claims in detail, often making determinations on claim validity. Both roles require similar credentials and work in comparable environments, but Claims Examiners usually have more specialized knowledge and decision-making authority.

Is being a claims associate hard?

Claims associates handle insurance claims processing, which requires attention to detail, strong communication skills, and knowledge of insurance policies. The job can be challenging due to the need for accuracy, meeting deadlines, and managing complex cases, but it is generally manageable with proper training and experience.

What is a claims associate in claims?

A claims associate is a professional who reviews, processes, and manages insurance claims to determine coverage and settlement amounts. They often work with claim documentation, use claims management software, and ensure compliance with company policies and industry regulations.
More about Claims Associate jobs

What are the most commonly searched types of Claims jobs in Puerto Rico?

The most popular types of Claims jobs in Puerto Rico are:

What are popular job titles related to Claims Associate jobs in Puerto Rico?

For Claims Associate jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Claims Associate jobs in Puerto Rico look for?

The top searched job categories for Claims Associate jobs in Puerto Rico are:

Claims Associate jobs near you

Pharmacy Customer Service Assoc. Cert

Walgreens

Carolina, PR • On-site

Full-time

This job post has expired today. Applications are no longer accepted.

Walgreens rating

5.5

Company rating: 5.5 out of 10

Based on 2,203 frontline employees who took The Breakroom Quiz

98th of 112 rated pharmacies

Job description

Job Objectives
Models and delivers a distinctive and delightful customer experience.  
Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient checkout service.
In accordance with state and federal regulations, assists the pharmacist, under direct supervision, in the practice of pharmacy.  Responsible for using pharmacy systems to obtain patient and drug information and process prescriptions. 
Job Responsibilities/Tasks
 
Customer Experience
  • Engages customers and patients by greeting them and offering assistance with products and services.  Resolves customer issues and answers questions to ensure a positive customer experience.
  • Models and shares customer service best practices with all team members to deliver a distinctive and delightful customer experience, including interpersonal habits (e.g., greeting, eye contact, courtesy, etc.) and Walgreens service traits (e.g., offering help proactively, identifying needs, servicing until satisfied, etc.).
Operations
  • Provides customers with courteous, friendly, fast, and efficient service.
  • Recommends items for sale to customer and recommends trade-up and/or companion items.
  • Registers customer purchases on assigned cash register, collects cash and distributes change as requested; processes voids, returns, rain checks, refunds, and exchanges as needed.  Takes customer to OTC aisle when possible to assist in locating products.
  • Keeps counters and shelves clean and well merchandised, takes inventory, and maintains records.  Checks in and prices merchandise as required or as directed by store manager or communicated by the shift leader.
  • Performs duties as assigned by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly,  filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions.  Assists pharmacists in scheduling and maintaining work flow.
  • Reports, immediately, prescription errors to pharmacist on duty and adheres to Company policies and procedures in relation to pharmacy errors and the Quality Improvement Program. Reviews and complies with the Walgreen Co. Pharmacy Code of Conduct.
  • Strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription dispensing activities.
  • Handles telephone calls that do not require personal attention of the pharmacist, including those to physicians.
  • Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.
  • Assists and supports Pharmacy Department on inventory management activities, such as, ordering, unpacking, checking and storing shipment of pharmaceuticals.  Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages (merchandise billed, but not received), order errors or damaged goods involving Rx drugs.
  • Ensures compliance with state and local laws regarding regulated products (e.g., alcoholic beverages and tobacco products).
  • Constructs and maintains displays, including promotional, seasonal, super structures, and sale merchandise.  Completes resets and revisions as directed.
  • Assists with separation of food items (e.g., raw foods from pre-cooked) and product placement as specified by policies/procedures (e.g., raw and frozen meats on bottom shelves).  For consumable items, assists in stock rotation, using the first in, first out method and restock outs.
  • Has working knowledge of store systems and store equipment.
  • Provides customer service in the photo area, including digital passport photo service, poster print and creative machine, suggestive sell of promotional photo products.
  • Assumes web pick-up responsibilities (monitors orders in Picture Care Plus, fills orders (pick items), delivers orders to customers as they arrive at store).
  • Assists with exterior and interior maintenance by ensuring clean, neat, orderly store condition and appearance.
  • Complies with all company policies and procedures; maintains respectful relationships with coworkers.
  • Completes special assignments and other tasks as assigned.
Training & Personal Development
  • Earns and maintains PTCB certification through the designated PTCB training program and/or state required certification/registration.
  • Attends training and completes PPLs requested by Manager or assigned by corporate and acquires continuing education credits.  Maintains knowledge and skill in healthcare and pharmacy, including latest news and developments.

About Walgreens 
Founded in 1901, Walgreens (www.walgreens.com) proudly serves more than 9 million customers and patients each day across its approximately 8,000 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities. 

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