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What is a claims representative and how to become one

Updated January 8, 2025
4 min read
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A claims representative works for an insurance company to investigate and process claims. They interact with policyholders to gather information, review policies and coverage, and determine the validity of the claim. Claims representatives also work with adjusters, medical professionals, and experts to evaluate damages and resolve claims efficiently. They must have excellent communication skills, attention to detail, and fair decision-making practices. Overall, they ensure policyholders receive fair compensation and protect the interests of the insurance company.

ScoreClaims RepresentativeUS Average
Salary
3.0

Avg. Salary $38,796

Avg. Salary $59,228

Stability level
9.3

Growth rate -6%

Growth rate 0.3%

Diversity
4.6
Race

American Indian and Alaska Native 0.50%

Asian 5.14%

Black or African American 11.03%

Hispanic or Latino 16.49%

Unknown 4.39%

White 62.44%

Gender

female 62.55%

male 37.45%

Age - 43
Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 43
Stress level
9.3

Stress level is very high

7.1 - high

Complexity level
9.7

Complexity level is advanced

7 - challenging

Work life balance
3.7

Work life balance is poor

6.4 - fair

What are the pros and cons of being a claims representative?

Pros

  • Competitive salary and benefits

  • Opportunity to work remotely

  • Job stability and security

  • Opportunities for teamwork and collaboration

  • Flexibility in work schedule

Cons

  • High stress and pressure to meet deadlines

  • Repetitive tasks and processes

  • Long hours or mandatory overtime during peak seasons

  • Working weekends or holidays

  • Limited decision-making authority

Claims representative career paths

Key steps to become a claims representative

  1. Explore claims representative education requirements

    Most common claims representative degrees

    Bachelor's

    62.3 %

    Associate

    15.5 %

    High School Diploma

    10.0 %
  2. Start to develop specific claims representative skills

    SkillsPercentages
    Customer Service25.90%
    Quality Standards6.46%
    Policy Coverage6.39%
    Reservations5.21%
    Claims Handling3.39%
  3. Complete relevant claims representative training and internships

    Accountants spend an average of 1-2 years on post-employment, on-the-job training. New claims representatives learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a claims representative based on U.S. Bureau of Labor Statistics data and data from real claims representative resumes.
  4. Gain additional claims representative certifications

    Claims representative certifications can show employers you have a baseline of knowledge expected for the position. Certifications can also make you a more competitive candidate. Even if employers don't require a specific claims representative certification, having one may help you stand out relative to other applicants.

    The most common certifications for claims representatives include Associate in Claims (AIC) and Certified Billing and Coding Specialist (CBCS).

    More About Certifications
  5. Research claims representative duties and responsibilities

    • Perform initial set-up and continuously manage claims in the Juris claims management system.
    • Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
    • Prepare necessary state filings within statutory limits, manage litigation and vocational rehabilitation process, used appropriate cost containment techniques.
    • Assist the training department in developing CSR training in order to set expectations.
  6. Prepare your claims representative resume

    When your background is strong enough, you can start writing your claims representative resume.

    You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a claims representative resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

    Choose from 10+ customizable claims representative resume templates

    Build a professional claims representative resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your claims representative resume.
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  7. Apply for claims representative jobs

    Now it's time to start searching for a claims representative job. Consider the tips below for a successful job search:

    1. Browse job boards for relevant postings
    2. Consult your professional network
    3. Reach out to companies you're interested in working for directly
    4. Watch out for job scams

How did you land your first claims representative job

Zippi

Are you a claims representative?

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Average claims representative salary

The average claims representative salary in the United States is $38,796 per year or $19 per hour. Claims representative salaries range between $28,000 and $53,000 per year.

Average claims representative salary
$38,796 Yearly
$18.65 hourly

What am I worth?

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How do claims representatives rate their job?

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3 stars

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Claims representative reviews

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A zippia user wrote a review on Aug 2021
Cons

When customers are not satisfied even when you know you have delivered the best service you could have and have gone beyond the call of duty in delivering same. They appear to not understand the dynamics of the process even if explained to them


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A zippia user wrote a review on Aug 2019
Pros

Working from home


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A zippia user wrote a review on May 2019
Pros

I'm gratified by forensics, accounting, mistakes, proceedure and changing codes and law.

Cons

That I know I make more money working in many other fields.


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Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

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