Claims representative vs claims administrator

The differences between claims representatives and claims administrators can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 4-6 years to become a claims representative, becoming a claims administrator takes usually requires 2-4 years. Additionally, a claims representative has an average salary of $38,796, which is higher than the $36,432 average annual salary of a claims administrator.

The top three skills for a claims representative include customer service, quality standards and policy coverage. The most important skills for a claims administrator are data entry, customer service, and process claims.

Claims representative vs claims administrator overview

	Claims Representative	Claims Administrator
Yearly salary	$38,796	$36,432
Hourly rate	$18.65	$17.52
Growth rate	-6%	-3%
Number of jobs	18,565	59,006
Job satisfaction	-	4
Most common degree	Bachelor's Degree, 62%	Bachelor's Degree, 53%
Average age	44	44
Years of experience	6	4

What does a claims representative do?

A Claims Representative is an agent who works for insurance companies in order to investigate and settle claims. The agent acts as an intermediary between customers and insurance companies by evaluating the customers' facts surrounding claims and determining whether the loss is covered or should be compensated. Such a role is important because an agent makes sure that no fraud claims are being paid out. It is also highlighted that an agent works in compliance with state regulations.

What does a claims administrator do?

Claims administrators are professionals who are responsible for performing administrative duties related to insurance claims. These administrators must collaborate with insurance companies so that they can analyze claims and determine the extent of the company's liability. They must review billing and process claims correctly by identifying provider information and other documentation to ensure a prompt payout. Claims administrators must also maintain and manage the compensation files of all workers in order to conduct preliminary investigations on work-related injuries for worker's compensation claims.

Claims representative vs claims administrator salary

Claims representatives and claims administrators have different pay scales, as shown below.

	Claims Representative	Claims Administrator
Average salary	$38,796	$36,432
Salary range	Between $28,000 And $53,000	Between $29,000 And $44,000
Highest paying City	Dearborn, MI	Reno, NV
Highest paying state	New Jersey	Connecticut
Best paying company	W. R. Berkley	ABB
Best paying industry	Government	Hospitality

Differences between claims representative and claims administrator education

There are a few differences between a claims representative and a claims administrator in terms of educational background:

	Claims Representative	Claims Administrator
Most common degree	Bachelor's Degree, 62%	Bachelor's Degree, 53%
Most common major	Business	Business
Most common college	Stanford University	-

Claims representative vs claims administrator demographics

Here are the differences between claims representatives' and claims administrators' demographics:

	Claims Representative	Claims Administrator
Average age	44	44
Gender ratio	Male, 37.5% Female, 62.5%	Male, 28.9% Female, 71.1%
Race ratio	Black or African American, 11.0% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%	Black or African American, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	11%

Differences between claims representative and claims administrator duties and responsibilities

Claims representative example 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.
Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
Utilize proper SIU reporting procedures for extensive investigation as required.

Claims administrator example responsibilities.

Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
Implement HIPAA regulations to protect patient privacy.
Adjudicate medical, commercial and Medicaid, claims.
Code medical records by following current ICD-9/ICD-10, CPT, and HCPCS standards.
Work with doctors, TPA, adjusters, attorneys, to maintain claim cost effectively.
Process various compensation benefits applications for veterans in compliance with organizational laws, federal laws, rules and regulations.

Claims representative vs claims administrator skills

Common claims representative skills

Customer Service, 26%
Quality Standards, 6%
Policy Coverage, 6%
Reservations, 5%
Claims Handling, 3%
Insurance Coverage, 3%

Common claims administrator skills

Data Entry, 12%
Customer Service, 9%
Process Claims, 8%
Phone Calls, 7%
HR, 5%
Insurance Claims, 5%

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Claims Representative
Claims Representative vs Claims Administrator

Updated January 8, 2025

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