How to hire a claim specialist

How to hire a claim specialist, step by step

Here's a step-by-step claim specialist hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a claim specialist job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new claim specialist
• Step 8: Go through the hiring process checklist

What does a claim specialist do?

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1. Identify your hiring needs

   The claim specialist hiring process starts by determining what type of worker you actually need. Certain roles might require a full-time employee, whereas part-time workers or contractors can do others.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

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   Hiring the perfect claim specialist also involves considering the ideal background you'd like them to have. Depending on what industry or field they have experience in, they'll bring different skills to the job. It's also important to consider what levels of seniority and education the job requires and what kind of salary such a candidate would likely demand.

   The following list breaks down different types of claim specialists and their corresponding salaries.

   Type of Claim Specialist	Description	Hourly rate
   Claim Specialist	Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much... Show more	$12-32
   Medical Claims Examiner	A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to... Show more	$14-28
   Claims Service Representative	Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim... Show more	$14-20

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Customer Service
   • Litigation
   • Patients
   • Claims Handling
   • Quality Standards
   • Excellent Organizational
   • Medical Terminology
   • Excellent Interpersonal
   • Coverage Issues
   • Data Entry
   • Insurance Policies
   • Insurance Claims
   • Defense Counsel
   • CPT

   Check all skills

   Responsibilities:

   • Assist in the streamlining of EDI process to manage workflow of EDI claims.
   • Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
   • Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
   • Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
   • Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
   • Manage expedition of appeals via problem solving and collaboration with other departments.

   More claim specialist duties

3. Make a budget

   Including a salary range in your claim specialist job description is one of the best ways to attract top talent. A claim specialist can vary based on:

   • Location. For example, claim specialists' average salary in montana is 52% less than in new jersey.
   • Seniority. Entry-level claim specialists 60% less than senior-level claim specialists.
   • Certifications. A claim specialist with certifications usually earns a higher salary.
   • Company. Working for an established firm or a new start-up company can make a big difference in a claim specialist's salary.

   Average claim specialist salary

   $43,164yearly

   $20.75 hourly rate

   ---

   Entry-level claim specialist salary

   $27,000 yearly salary

   Updated January 23, 2026

   Average claim specialist salary by state

   Rank	State	Avg. salary	Hourly rate
   1	New Jersey	$59,932	$29
   2	Connecticut	$58,338	$28
   3	New York	$58,143	$28
   4	District of Columbia	$54,888	$26
   5	Massachusetts	$53,976	$26
   6	Michigan	$53,439	$26
   7	Virginia	$52,750	$25
   8	California	$51,050	$25
   9	Maryland	$47,117	$23
   10	Kansas	$46,947	$23
   11	Florida	$46,540	$22
   12	Washington	$46,347	$22
   13	Maine	$45,087	$22
   14	Indiana	$45,014	$22
   15	Wisconsin	$44,610	$21
   16	Delaware	$41,904	$20
   17	Oregon	$41,381	$20
   18	Georgia	$41,211	$20
   19	Texas	$41,135	$20
   20	Missouri	$41,129	$20

   Average claim specialist salary by company

   Company

   Rank	Company	Average salary	Hourly rate	Job openings
   1	W. R. Berkley	$99,721	$47.94	19
   2	Chubb	$92,513	$44.48	68
   3	BERKLEY TECHNOLOGY SERVICES	$92,508	$44.48	30
   4	JPMorgan Chase & Co.	$88,744	$42.67	10
   5	Fifth Third Bank	$87,564	$42.10	12
   6	Calpine	$86,764	$41.71
   7	Capgemini	$78,599	$37.79	4
   8	Toyota Financial Svc	$78,426	$37.70
   9	Prudential Bank	$78,104	$37.55	5
   10	EMC Insurance	$77,580	$37.30	4
   11	EXL	$76,994	$37.02
   12	Equifax	$76,529	$36.79
   13	Amerisure Insurance	$75,622	$36.36	15
   14	APN	$75,317	$36.21
   15	Interra International	$75,233	$36.17
   16	Zurich	$73,466	$35.32	135
   17	The Travelers Companies	$72,986	$35.09	175
   18	CNA Insurance	$72,558	$34.88	28
   19	Philadelphia Insurance Companies	$71,837	$34.54	16
   20	Great American Insurance	$70,848	$34.06	102

4. Writing a claim specialist job description

   A claim specialist job description should include a summary of the role, required skills, and a list of responsibilities. It's also good to include a salary range and the first name of the hiring manager. Below, you can find an example of a claim specialist job description:

   Claim specialist job description example

   Responsible for handling large, complex claim files, including litigated matters, catastrophic claims, umbrella claims, punitive damage claims, severe injury, long duration indemnity, permanent total disability, structural building damage, multiple location damage, including business income exposure and other extensive exposure claims, in accordance with applicable state and federal laws. Set reserves and settle claims within level of authority. Direct work of defense attorney. Actively share knowledge with team members, contribute to training programs, and mentor other claim representatives.
   Responsibilities I. Perform claim tasks timely and document claim files appropriately. Proactively manage claim activities to ensure fair claim resolution. Handle all claims in accordance with state and federal laws. II. Make complex coverage decisions by gathering information necessary to make an informed decision in a fair, equitable, and ethical manner. Deny losses within authority level, providing detailed explanation, citing facts, and policy language. III. Perform a thorough investigation based upon the type, complexity, and severity of the claim. Inspect loss sites as necessary. Upon completion of the investigation, analyze and evaluate the potential high exposure and extensive damages, including potential full or partial liability and compensability denials. Formulate and document an action plan based on the covered damages and injuries. IV. Determine and set reserves based on the most probable outcome of the claim, within authority level. Evaluate and negotiate directly with insured, claimant, or claimant's attorney on all cases within authority level. Review claim facts and exposure with claims management, as appropriate, to guide claim strategy. Make complete, accurate, and timely payments within authority for covered losses. V. Maintain a professional, courteous, and helpful approach when communicating in-person, on the phone, or through email and other correspondence with internal and external customers, business partners, and brokers. VI. Provide knowledge and guidance to other claim handlers regarding claim strategy, coverage interpretations, and in-depth jurisdictional and legal nuances. Field questions from team members related to coverage/compensability decisions. VII. Investigate and refer identified claims to Loss Recovery Services, as applicable. VIII. Direct work of defense attorney through collaboration on claim strategy and resolution. Ensure defense attorney is adhering to Litigation Management guidelines. Manage claim expense by concluding vendor assignment when vendor is no longer adding value to the claim. IX. Engage in direct investigation, control, and settlement negotiations when outside adjusting and legal services are not necessary or available. X. Attend mediations, depositions, and trials. Present complex claim files during roundtables and claims committee meetings. Qualifications 1. Prior Experience: Eight or more years in technical insurance claim roles with increasing responsibilities is required. 2. Education: • Bachelor's degree preferred. A combination of equivalent education and/or experience may be considered in lieu of a degree.
   • Evidence of continuing education in the insurance industry is required.
   • Additional legal education or law degree is highly desirable.
   • Completion of AIC and/or CPCU is preferred. 3. Necessary Knowledge and Abilities: • Ability to obtain and maintain state adjusting license requirements and complete continuing education requirements.
   • Advanced knowledge of recoveries such as subrogation, reinsurance, apportionment, and deductibles.
   • Advanced knowledge of reinsurance contracts, workers compensation pools, second injury funds, etc.
   • Advanced negotiation skills.
   • Strong listening, verbal, and written communication skills.
   • Advanced knowledge of policy terminology, legal principles involving insurance, and emerging industry trends.
   • Effective planning and organization skills.
   • Ability to travel to inspect loss sites, attend mediations, depositions, etc. We can recommend jobs specifically for you! Click here to get started.

   Copy this example

   

5. Post your job

   To find claim specialists for your business, try out a few different recruiting strategies:

   • Consider internal talent. One of the most important talent pools for any company is its current employees.
   • Ask for referrals. Reach out to friends, family members, and your current work to ask if they know any claim specialists they would recommend.
   • Recruit at local colleges. Attend job fairs at local colleges to recruit entry-level claim specialists with the right educational background.
   • Social media platforms. LinkedIn, Facebook, and Twitter have more than 3.5 billion users, and they're a great place for company branding and reaching potential job candidates.

   Post your job online:

   • Post your claim specialist job on Zippia to find and recruit claim specialist candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   To successfully recruit claim specialists, your first interview needs to engage with candidates to learn about their interest in the role and experience in the field. You can go into more detail about the company, the role, and the responsibilities during follow-up interviews.

   It's also good to ask about candidates' unique skills and talents to see if they match your ideal candidate profile. If you think a candidate is good enough for the next step, you can move on to the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new claim specialist

   Once you have selected a candidate for the claim specialist position, it is time to create an offer letter. In addition to salary, the offer letter should include details about benefits and perks that are available to the employee. Ensuring your offer is competitive is vital, as qualified candidates may be considering other job opportunities. The candidate may wish to negotiate the terms of the offer, and it is important to be open to discussion and reach a mutually beneficial agreement. After the offer has been accepted, it is a good idea to formalize the agreement with a contract.

   It's also good etiquette to follow up with applicants who don't get the job by sending them an email letting them know that the position has been filled.

   To prepare for the new employee's start date, you can create an onboarding schedule and complete any necessary paperwork, such as employee action forms and onboarding documents like I-9 forms, benefits enrollment, and federal and state tax forms. Human Resources should also ensure that a new employee file is created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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