What does a claims associate do?
Claims associates control claims for insurance companies. Their job duties include determining a customer's insurance coverage and evaluating those who have filed a claim. Also, they must make sure that a claim is analyzed correctly for the clients to receive their entitled financial settlement. The work may require the agent to travel to generate information about the claim and may vary from a different position in the insurance industry. Qualifications for the job include an associate degree, excellent interpersonal and research skills as well as relevant experience in customer service.
Claims associate responsibilities
Here are examples of responsibilities from real claims associate resumes:
- Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
- Obtain vehicle information from the DMV.
- Follow HIPAA policy on each and every call.
- Abided by the laws and regulations associate under HIPAA and patient confidentiality.
- Receive recognition for creating a workflow and database for all incoming subpoenas.
- Assist in training new CSA s on job responsibilities, which increase office productivity.
- Ensure compliance with company regulations and Medicaid requirements.
- Coordinate Medicare, Medicaid, and secondary insurance coverage.
- Gather and compile evidence to support contest claims in litigation.
- Review automobile titles, completing transfers and owner retention DMV documents with customers
- Conduct detail bill reviews to implement sound litigation management and expense control.
- Identify claims for potential fraud and abuse and process expedited appeals and organizational determinations
- Devise creative and cost-effective incentive and morale-boosting programs that increase CSA satisfaction and productivity.
- Execute effective and efficient claim dispute resolutions in regard to provider and facility appeals.
- Assist veterans and their dependents in determining eligibility for VA benefits via phone contact and personal interview.
Claims associate skills and personality traits
We calculated that 14% of Claims Associates are proficient in Customer Service, Medical Claims, and Phone Calls. They’re also known for soft skills such as Organizational skills, Math skills, and Communication skills.
We break down the percentage of Claims Associates that have these skills listed on their resume here:
- Customer Service, 14%
Awarded company based certifications in anatomy, medical terminology, claims resolution, customer service, and customer conflict resolution.
- Medical Claims, 8%
Process incoming medical claims from providers*Responded and acted upon verbal and written requests with thorough follow-up leading to resolution.
- Phone Calls, 8%
Responded to priority telephone calls courteously and professionally and maintained appropriate documentation of phone inquiries.
- Claims Handling, 7%
Demonstrated a comprehensive understanding of property and casualty claims handling.
- Insurance Claims, 6%
Dedicated dual skilled insurance professional with experience in investigating and processing automobile and home insurance claims.
- Medical Terminology, 5%
Directed walk-in assistance for one-on-one interaction with customers while utilizing medical terminology.
Most claims associates use their skills in "customer service," "medical claims," and "phone calls" to do their jobs. You can find more detail on essential claims associate responsibilities here:
Organizational skills. One of the key soft skills for a claims associate to have is organizational skills. You can see how this relates to what claims associates do because "financial clerks must be able to arrange files so they can find them quickly and efficiently." Additionally, a claims associate resume shows how claims associates use organizational skills: "full understanding of benefits coordination verification of coding and keying of claims effective customer service, organizational and presentation skills. "
Math skills. Many claims associate duties rely on math skills. "the job duties of financial clerks includes calculating charges and updating financial records.," so a claims associate will need this skill often in their role. This resume example is just one of many ways claims associate responsibilities rely on math skills: "keep inventory accurate skills used strong communication skills, customer service skills and basic math skills"
Communication skills. claims associates are also known for communication skills, which are critical to their duties. You can see how this skill relates to claims associate responsibilities, because "financial clerks should be able to explain policies and procedures to colleagues and customers." A claims associate resume example shows how communication skills is used in the workplace: "researched telecommunications insurance claims for fraud prevention. "
The three companies that hire the most claims associates are:
- Sedgwick LLP153 claims associates jobs
- State Farm11 claims associates jobs
- Zurich10 claims associates jobs
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Compare different claims associates
Claims associate vs. Insurance biller
An insurance biller is responsible for making daily reviews and processing documents concerning the insurance payment and bills of a client. They assess if all requirements are correct and complete, obtain different referrals and authorization papers, and prepare and transmit document claims using a particular software. Also, they do follow ups regarding unpaid claims and update spreadsheets for record purposes.
There are some key differences in the responsibilities of each position. For example, claims associate responsibilities require skills like "taking care," "customer service," "phone calls," and "claims handling." Meanwhile a typical insurance biller has skills in areas such as "patients," "cpt," "medi-cal," and "data entry." This difference in skills reveals the differences in what each career does.
On average, insurance billers reach similar levels of education than claims associates. Insurance billers are 2.3% less likely to earn a Master's Degree and 0.6% less likely to graduate with a Doctoral Degree.Claims associate vs. Insurance clerk
An insurance clerk usually works to process insurance, reinstatement, changes, or cancellations for a company or an individual account. They are responsible for monitoring, processing, and organizing different insurance claims for a client. They usually work closely with the company's insurance agent to provide necessary information to process the clients' application. This career requires a broad knowledge of local and state insurance policies, good attention to detail, excellent communication skills, customer service skills, and administrative skills.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that claims associate responsibilities requires skills like "taking care," "medical claims," "phone calls," and "claims handling." But an insurance clerk might use other skills in their typical duties, such as, "patients," "insurance verification," "data entry," and "insurance coverage."
On average, insurance clerks earn a lower salary than claims associates. Some industries support higher salaries in each profession. Interestingly enough, insurance clerks earn the most pay in the finance industry with an average salary of $33,939. Whereas claims associates have higher pay in the insurance industry, with an average salary of $36,073.In general, insurance clerks achieve similar levels of education than claims associates. They're 2.0% less likely to obtain a Master's Degree while being 0.6% less likely to earn a Doctoral Degree.Claims associate vs. Insurance coordinator
An insurance coordinator is responsible for evaluating and validating insurance information to verify claims and process the necessary claims resolutions for parties. Insurance coordinators submit claims statements timely to the insurance officers for review, coordinate with the clients for inquiries and updates, and reach out to medical institutions for accurate filing of payments. An insurance coordinator must have excellent communication and analytical skills to assess reports, resolve claims discrepancies, and escalate high-level complaints to the officers for immediate action.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a claims associate is likely to be skilled in "taking care," "phone calls," "claims handling," and "inbound calls," while a typical insurance coordinator is skilled in "patients," "insurance verification," "strong customer service," and "insurance eligibility."
Insurance coordinators earn the highest salary when working in the pharmaceutical industry, where they receive an average salary of $33,609. Comparatively, claims associates have the highest earning potential in the insurance industry, with an average salary of $36,073.When it comes to education, insurance coordinators tend to earn similar degree levels compared to claims associates. In fact, they're 0.6% less likely to earn a Master's Degree, and 0.2% less likely to graduate with a Doctoral Degree.Claims associate vs. Social insurance administrator
Types of claims associate
Updated January 8, 2025
