Claims representative vs claims coordinator

The differences between claims representatives and claims coordinators can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a claims representative and a claims coordinator. Additionally, a claims representative has an average salary of $38,796, which is higher than the $38,620 average annual salary of a claims coordinator.

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

Claims representative vs claims coordinator overview

	Claims Representative	Claims Coordinator
Yearly salary	$38,796	$38,620
Hourly rate	$18.65	$18.57
Growth rate	-6%	-6%
Number of jobs	18,565	27,332
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 62%	Bachelor's Degree, 48%
Average age	44	44
Years of experience	6	6

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 coordinator do?

Claims coordinators are professionals who are responsible for coordinating activities that are related to handling and processing insurance claims for an organization. These coordinators must serve as liaison officer between the organization, insurance provider, and policyholders to communicate the status and eligibility for coverage for all relevant claims. They need to ensure that billing requirements are met by reviewing insurance claims. Claims coordinators must also answer all the inquiries of their clients while making recommendations to resolve any claim issues.

Claims representative vs claims coordinator salary

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

	Claims Representative	Claims Coordinator
Average salary	$38,796	$38,620
Salary range	Between $28,000 And $53,000	Between $31,000 And $47,000
Highest paying City	Dearborn, MI	Federal Way, WA
Highest paying state	New Jersey	New Jersey
Best paying company	W. R. Berkley	Xcel Energy
Best paying industry	Government	Finance

Differences between claims representative and claims coordinator education

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

	Claims Representative	Claims Coordinator
Most common degree	Bachelor's Degree, 62%	Bachelor's Degree, 48%
Most common major	Business	Business
Most common college	Stanford University	-

Claims representative vs claims coordinator demographics

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

	Claims Representative	Claims Coordinator
Average age	44	44
Gender ratio	Male, 37.5% Female, 62.5%	Male, 24.6% Female, 75.4%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims representative and claims coordinator 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 coordinator example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Process and adjust Medicare claims, provide feedback to providers on proper CPT, ICD-9 coding for billing purposes.
Serve as point of contact for all legal issues relate to HIPAA.
Streamline audit procedures of TPA and maintain extremely high production rate which help in keeping staffing requirements lower.
Review and audit claims -Using correct CPT and DX codes -Denial reports -correct billing error, resubmitted claims for proper payment
Communicate with company management, injure workers/customers, medical providers and TPA, as necessary, regarding claim relate matters.

Claims representative vs claims coordinator skills

Common claims representative skills

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

Common claims coordinator skills

Customer Service, 23%
Patients, 9%
Data Entry, 8%
Phone Calls, 6%
Insurance Claims, 5%
Quality Standards, 4%

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Claims Representative vs Claims Coordinator

Updated January 8, 2025

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