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Claims representative vs claims clerk

The differences between claims representatives and claims clerks 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 clerk takes usually requires 2-4 years. Additionally, a claims representative has an average salary of $38,796, which is higher than the $32,815 average annual salary of a claims clerk.

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

Claims representative vs claims clerk overview

Claims RepresentativeClaims Clerk
Yearly salary$38,796$32,815
Hourly rate$18.65$15.78
Growth rate-6%-3%
Number of jobs18,56578,588
Job satisfaction--
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 31%
Average age4444
Years of experience64

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 clerk do?

Claims clerks review the forms and documents for insurance claims to check for missing information and attachments. The data they obtain is entered into their database for safekeeping and quick retrieval. They should know the answers to their clients' questions about the regulations, policies, and procedures covered by their insurance policy. These clerks prepare documents that their agents use to present to their clients. When working for this position, a person must have the ability to communicate well and be familiar with computer applications.

Claims representative vs claims clerk salary

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

Claims RepresentativeClaims Clerk
Average salary$38,796$32,815
Salary rangeBetween $28,000 And $53,000Between $27,000 And $39,000
Highest paying CityDearborn, MI-
Highest paying stateNew Jersey-
Best paying companyW. R. Berkley-
Best paying industryGovernment-

Differences between claims representative and claims clerk education

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

Claims RepresentativeClaims Clerk
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 31%
Most common majorBusinessBusiness
Most common collegeStanford University-

Claims representative vs claims clerk demographics

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

Claims RepresentativeClaims Clerk
Average age4444
Gender ratioMale, 37.5% Female, 62.5%Male, 17.5% Female, 82.5%
Race ratioBlack 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 Percentage10%11%

Differences between claims representative and claims clerk 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.
    • Show more

Claims clerk example responsibilities.

  • Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
  • File commercial, worker's comp, Medicare, and Medicaid claims to insurance carriers and employers.
  • Open and sort mail by claim types (HCPA UB 92 and T18).
  • Process medical HMO claims, POS claims, PPO claims and fee for service claims.
  • Review, scan, and file HCFA forms
  • Audit paper claims for accuracy in CPT and ICD9 codes.
    • Show more

Claims representative vs claims clerk skills

Common claims representative skills
  • Customer Service, 26%
  • Quality Standards, 6%
  • Policy Coverage, 6%
  • Reservations, 5%
  • Claims Handling, 3%
  • Insurance Coverage, 3%
Common claims clerk skills
  • Data Entry, 26%
  • Customer Service, 9%
  • Clerical Support, 7%
  • Computer System, 5%
  • Medical Claims, 4%
  • Process Claims, 4%

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Updated January 8, 2025

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