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Become A Claims Representative

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Working As A Claims Representative

  • Interacting With Computers
  • Evaluating Information to Determine Compliance with Standards
  • Communicating with Supervisors, Peers, or Subordinates
  • Documenting/Recording Information
  • Getting Information
  • Mostly Sitting

  • Repetitive

  • $34,430

    Average Salary

What Does A Claims Representative Do At Kelly Services

* Able to handle more complex claims.
* Good understanding of the application of benefit contracts, pricing, processing, policies, procedures, government regulations, coordination of benefits, and healthcare terminology.
* Good working knowledge of claims and products, including the grievance and/or re-consideration process.
* Excellent knowledge of the various operations of the organization, products, and services.
* Reviews, analyzes and processes claims/policies related to events to determine extent of company's liability and entitlement.
* Researches and analyzes claims issues.
* Responds to inquiries, may involve customer/client contact.
* Must meet production and quality standards.
* Claims processing accuracy of 99% and above and the ability to process 120 or more claims per day.
* Proficient in claims adjudication and knowledge of Medicare

What Does A Claims Representative Do At Liberty Mutual

* Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
* Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
* Determines policy coverage through analysis of investigation data and policy terms.
* Notifies agent and insured of coverage or any issues.
* Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims.
* Determines and negotiates settlement amount for damages claimed within assigned authority limits.
* Writes simple to moderately complex property damage estimates or review auto damage estimates.
* Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
* Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
* Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed

What Does A Claims Representative Do At Robert Half

* Review, monitor and analyze reimbursements due from state and commercial health plans and follow the collection processes determined by the Collections Lead.
* Reduce the health plan aging balances by collecting outstanding monies owed.
* Help identify, investigate and resolve claim denial issues with contracted health plans as assigned by Collections Lead or Supervisor.
* Establish a positive working relationship with contracted state and commercial health plans.
* Assists with reporting metrics as necessary.
* Communicates effectively and professionally with both internal and external representatives.
* Suggest workflow and process improvement with other billing and collections personnel.
* Processes recoup requests accordingly, documenting and appealing if necessary.
* Create claims on paper
* Follow up on appeals

What Does A Claims Representative Do At Travelers

* Handle all types of automobiles, and a variety of heavy and mobile equipment (i.e. cranes, tractor trailers, construction, agricultural equipment) at every severity level excluding other property damage i.e.: guard rails, mail boxes and any property within the vehicle.
* Contact all appropriate parties to gather supporting documents necessary to negotiate and settle the claim within their authority level (i.e.; obtaining the title, keys, and other required documentation).
* Review controlling claim handlers' coverage determination, summarize the review and seek clarification as needed.
* Recognize additional coverage issues (i.e. covered equipment, endorsements).
* Establish and/or update claim and expense reserves.
* Control damages through the proper use of cost containment tools (i.e. mitigate storage, expenses, rental).
* Properly manage Total Loss settlement process and rental expenses by working closely with appraisers, rental facilities, body shops, and salvage vendors.
* Manage deductibles and limits.
* Review the valuation (appraisal estimate) based on the type of vehicle to effectively and efficiently resolve the claim.
* Meet all quality standards and expectations per Best Practices.
* Maintain an effective diary system, manage file inventory, and document claim file activities in accordance with established procedures.
* Comply with state specific regulations.
* Provide quality customer service to meet the needs of the insured, claimant, all internal and external customers.
* May participate with property ERT during extreme weather events.
* In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements.
* Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated.
* Perform other duties as assigned.
* Job Opening ID:
* BR
* Equal Employment Opportunity Statement:
* Travelers is an equal opportunity employer

What Does A Claims Representative Do At Unitedhealth Group

* Review, research, analyze and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g.
* verify pricing, prior authorizations, applicable benefits)Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g.
* claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool)Complete data entry for all daily documentation and communicate the status of claims adhering to reporting requirementsCommunicate through correspondence with members and providers regarding claim payment or required information using clear, simple language to ensure understandingLearn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g

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How To Become A Claims Representative

A high school diploma or equivalent is typically required for most financial clerk jobs. These workers usually learn their duties through on-the-job training.


Financial clerks typically need a high school diploma or equivalent to enter the occupation. Employers of brokerage clerks may prefer candidates who have taken some college courses in business or economics and, in some cases, require a 2- or 4-year college degree.


Most financial clerks learn how to do their job duties through on-the-job training. Some formal technical training also may be necessary; for example, gaming cage workers may need training in specific gaming regulations and procedures.


Financial clerks can advance to related occupations in finance. For example, a loan interviewer or clerk can become a loan officer, and a brokerage clerk can become a securities, commodities, or financial services sales agent, after obtaining the required education and license.

Important Qualities

Communication skills. Financial clerks should have good communication skills so that they can explain policies and procedures to colleagues and customers.

Math skills. The job duties of financial clerks, including calculating charges and checking credit scores, require basic math skills.

Organizational skills. Strong organizational skills are important for financial clerks because they must be able to find files quickly and efficiently.

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Claims Representative jobs

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Claims Representative Career Paths

Claims Representative
Office Manager Accounts Payable Clerk
Account Payables Analyst
6 Yearsyrs
Senior Claims Representative Claim Specialist Billing Specialist
Accounts Receivable Manager
6 Yearsyrs
Senior Claims Representative Claim Processor Accounts Receivable Specialist
Accounts Receivable Supervisor
5 Yearsyrs
Specialist Service Manager Office Manager
Administrative Manager
6 Yearsyrs
Account Manager Chief Executive Officer Administrative Coordinator
Administrative Supervisor
5 Yearsyrs
Claim Specialist Billing Specialist
Billing Manager
7 Yearsyrs
Claim Specialist Account Manager Billing Specialist
Billing Office Manager
6 Yearsyrs
Office Manager Billing Specialist
Billing Supervisor
6 Yearsyrs
Account Manager Human Resources Coordinator Business Office Manager
Business Office Director
8 Yearsyrs
Claims Adjuster Claim Specialist Billing Specialist
Business Office Manager
8 Yearsyrs
Claims Adjuster
Claims Supervisor
7 Yearsyrs
Analyst Operations Analyst Intelligence Analyst
Collections Manager
5 Yearsyrs
Paralegal Tax Preparer Customer Care Representative
Customer Care Supervisor
5 Yearsyrs
Accounts Receivable Specialist Legal Assistant Assistant Office Manager
Executive Assistant/Office Manager
6 Yearsyrs
Sales Agent Operator Senior Operator
Office Lead
5 Yearsyrs
Specialist Account Manager Sales Manager
Office Manager
5 Yearsyrs
Claims Analyst Analyst Senior Consultant
Risk Manager
8 Yearsyrs
Account Executive Office Manager Billing Specialist
Senior Billing Specialist
7 Yearsyrs
Account Executive Sales Consultant Senior Sales Representative
Senior Representative
5 Yearsyrs
Case Manager Service Coordinator Service Supervisor
Service Lead
5 Yearsyrs
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Claims Representative Demographics


  • Female

  • Male

  • Unknown



  • White

  • Hispanic or Latino

  • Asian

  • Unknown

  • Black or African American

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Languages Spoken

  • Spanish

  • French

  • Carrier

  • Portuguese

  • German

  • Korean

  • Arabic

  • Italian

  • Vietnamese

  • Hindi

  • Chinese

  • Urdu

  • Romanian

  • Russian

  • Polish

  • Cherokee

  • Mandarin

  • Danish

  • Khmer

  • Dakota

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Claims Representative

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Claims Representative Education

Claims Representative

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Top Skills for A Claims Representative


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Top Claims Representative Skills

  1. Liability Claims
  2. Policy Coverage
  3. Customer Service
You can check out examples of real life uses of top skills on resumes here:
  • Handled Workmen's Compensation and General Liability claims
  • Review claim documents and conduct investigations to determine policy coverage.
  • Provide polite, efficient customer service while being sensitive to the needs of our aged, blind, and disabled clientele.
  • Conducted liability and coverage investigations for auto claims.
  • Assisted customers and insurance agents to positive and timely resolution of customer total loss

Top Claims Representative Employers

Claims Representative Videos

What It's Like Working in Claims at GEICO