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Claims representative vs senior claims examiner

The differences between claims representatives and senior claims examiners 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 senior claims examiner. Additionally, a senior claims examiner has an average salary of $50,962, which is higher than the $38,796 average annual salary of a claims representative.

The top three skills for a claims representative include customer service, quality standards and policy coverage. The most important skills for a senior claims examiner are customer service, litigation, and property damage.

Claims representative vs senior claims examiner overview

Claims RepresentativeSenior Claims Examiner
Yearly salary$38,796$50,962
Hourly rate$18.65$24.50
Growth rate-6%-6%
Number of jobs18,56510,931
Job satisfaction--
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 58%
Average age4444
Years of experience66

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 senior claims examiner do?

Senior claims examiners review, assess, and process the insurance claims of their clients. The examiners provide recommendations for claims-related resolution. It is their responsibility to examine and authorize the investigation of insurance claims as conducted by insurance adjusters. They check the claims and the insurance policies to ensure that all the information is right. During the settlement, they are expected to be careful in keeping the records with details of the process.

Claims representative vs senior claims examiner salary

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

Claims RepresentativeSenior Claims Examiner
Average salary$38,796$50,962
Salary rangeBetween $28,000 And $53,000Between $34,000 And $75,000
Highest paying CityDearborn, MIUrban Honolulu, HI
Highest paying stateNew JerseyHawaii
Best paying companyW. R. BerkleyW. R. Berkley
Best paying industryGovernmentFinance

Differences between claims representative and senior claims examiner education

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

Claims RepresentativeSenior Claims Examiner
Most common degreeBachelor's Degree, 62%Bachelor's Degree, 58%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claims representative vs senior claims examiner demographics

Here are the differences between claims representatives' and senior claims examiners' demographics:

Claims RepresentativeSenior Claims Examiner
Average age4444
Gender ratioMale, 37.5% Female, 62.5%Male, 29.6% Female, 70.4%
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, 10.8% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claims representative and senior claims examiner 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

Senior claims examiner example responsibilities.

  • Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
  • Coordinate vendor referrals for additional investigation and/or litigation management
  • Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
  • Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
  • Coordinate vendor referrals for additional investigation and/or litigation management

Claims representative vs senior claims examiner skills

Common claims representative skills
  • Customer Service, 26%
  • Quality Standards, 6%
  • Policy Coverage, 6%
  • Reservations, 5%
  • Claims Handling, 3%
  • Insurance Coverage, 3%
Common senior claims examiner skills
  • Customer Service, 21%
  • Litigation, 11%
  • Property Damage, 9%
  • Claims Handling, 6%
  • TPA, 4%
  • Coverage Issues, 4%

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Updated January 8, 2025

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