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Claims representative job description

Updated March 14, 2024
10 min read

A claims representative works with insurance companies in order to help settle insurance claims of all sorts, from health insurance to house or car insurance. They act as a liaison between the customer and the company. They also investigate and analyze claims to avoid fraud and negotiate settlements.

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Example claims representative requirements on a job description

Claims representative requirements can be divided into technical requirements and required soft skills. The lists below show the most common requirements included in claims representative job postings.
Sample claims representative requirements
  • Bachelor's degree or relevant experience in claims processing.
  • Experience with insurance claims processing.
  • Knowledge of relevant regulations, policies, and procedures.
  • Proficiency in relevant software applications.
  • Ability to analyze data and make decisions.
Sample required claims representative soft skills
  • Strong customer service skills.
  • Excellent communication and interpersonal skills.
  • Highly organized and detail-oriented.
  • Able to work in a fast-paced environment.
  • Ability to work independently and as part of a team.

Claims representative job description example 1

Njm Insurance Group claims representative job description

You work for NJM? That's a great company!" If you're hired at NJM, you'll hear it over and over again from friends, family and neighbors. Why? Because NJM is committed to providing its customers with superior service, and great service goes a long way. Why else is NJM called a great company? Because our employees enjoy working here, are appreciated, and are provided with a great benefits plan.

At New Jersey Manufacturers (NJM), a top-rated insurance company, our General Claims department in West Trenton, NJ is looking for a Customer Service Representative (Claims) candidate who has excellent communication skills as well as strong organizational and time management skills. The official NJM job title is Subrogation Claims Rep I.
Job Responsibilities:

Receive and process subrogation claims, seeking recoveries from adverse parties and/or their insurance carriers Thoroughly review, evaluate and investigate subrogation claims to obtain necessary information for prompt resolutions Negotiate subrogation claims and resolve liability and/or damage disputes for successful recoveries. Efficiently credit recovery checks and issue deductible payments to our insureds Send out subrogation demands and all follow up letters. Apply comparative negligence laws Professionally respond and communicate on all subrogation related issues. Coordinate efforts with the General Claims Department. Provide excellent customer service to our policyholders



Job Requirements:


Bachelor's degree is preferred Knowledge of Claims or Personal Lines area are a plus Ability to produce quality work in a timely fashion Must be detail oriented, organized, and possess strong time management skills Ability to multi-task, problem-solve and the ability to make decisions Must be computer literate and have a working knowledge of Microsoft Office Effective communication skills, including strong negotiation skills Prior claims experience is a plus



Salary Range:
$46,000 - $53,000. Salary is commensurate with experience and credentials.

Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
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Claims representative job description example 2

Farm Bureau Financial Services claims representative job description

Who We Are: With Farm Bureau Financial Services, our client/members can feel confident knowing their family, home, cars and other property are protected. We value a culture where integrity, teamwork, passion, service, leadership and accountability are at the heart of every decision we make and every action we take. We're proud of our more than 80-year commitment to protecting the livelihoods and futures of our client/members and creating an atmosphere where our employees thrive.

What You'll Do : As a Property Claims Representative, you will investigate, evaluate, negotiate and settle assigned claims involving multi-line insurance coverage. You must investigate the cause of the loss, interpret the policy, and determine whether the loss is covered. You will also determine the value of loss and assists in setting reasonable reserves. As a Property Claims Representative, you must keep a service-oriented attitude at all times by maintaining professional and productive relationships with coworkers, supervisors, agents, agency managers, claimants, policyholders, engineers, restoration specialists, general contractors, attorneys, and others. You will work out of the Phoenix, Arizona area, but will cover surrounding territories on a rotational basis.

What It Takes to Join Our Team:

  • College degree plus 3 years experience or equivalent required- claims experience a must.
  • Insurance and basic building material knowledge is strongly preferred.
  • High attention to detail, strong organizational skills and a good work ethic.
  • Strong verbal and written communication skills.
  • Exceptional customer service skills.
  • Must be able to work under all kinds of weather conditions and fully appraise all physical aspects of the property and buildings, which includes climbing on ladders.
  • A valid driver's license and satisfactory Motor Vehicle Records are required.
  • Some travel with overnight stays.
  • Must attend training schools as required.

What We Offer You: When you're on our team, you get more than a great paycheck. You'll hear about career development and educational opportunities. We offer an enhanced 401K with a match, low cost health, dental, and vision benefits, and life and disability insurance options. We also offer paid time off, including holidays and volunteer time, as well as a company car and cell phone. Farm Bureau....where the grass really IS greener!

If you're interested in joining a company that appreciates its employees, provides growth and professional development opportunities, and offers great benefits, we invite you to apply today

Work Authorization/Sponsorship
Applicants must be currently authorized to work in the United States on a full-time basis. We are not able to sponsor now or in the future, or take over sponsorship of, an employment visa or work authorization for this role. For example, we are not able to sponsor OPT status.

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Claims representative job description example 3

The Independent Traveler claims representative job description

Who Are We?Solid reputation, passionate people and endless opportunities. That's Travelers. Our superior financial strength and consistent record of strong operating returns mean security for our customers - and opportunities for our employees. You will find Travelers to be full of energy and a workplace in which you truly can make a difference.
Job Category
Claim

Target Openings
1

What Is the Opportunity?
Under close supervision, this position is responsible for investigating and evaluating, primarily low to moderate complexity claims, to determine coverage available to policyholders and claimants. This role is responsible for handling 1st and 3rd party Personal Insurance and Business Insurance APD claims. The APD role handles a wide variety of causes of loss. In addition, the role applies policy, legislation and company guidelines to all claims to manage loss costs and customer relations. Occasionally the APD role handles claims with complexities related to unique coverage and/or damage issues. This position does not manage staff.
What Will You Do?
Handling 1st and 3rd party PI and BI APD claims of low to moderate severity and complexity as assigned:Making contact with insured within Best Practice guidelines.Returning all phone calls and emails within Best Practice guidelines.Providing clear explanation of claims process and coverage to all customers.Acting as primary contact for customer and as intermediary between customer and other parties.Participating in extended hours duties as required.Advises underwriting of any information gathered which may affect risk assessment.Investigating and evaluating all relevant facts to determine coverage, damages and liability of first-party APD claims under a variety of policies.Conducting prompt investigation of coverage and liability.Documenting claims files in accordance with Best Practices.Managing pending and settles claims within company averages based on type of claim, complexity of claim and geographical area.Establishing accurate scope of damages and utilize as a basis for written estimates and/or computer assisted estimates:Working diary system to be proactive on files.Reviewing and analyzing policy conditions, provisions, exclusions and endorsements pertinent to a variety of APD losses.Reviewing amounts on all invoices and all documentation supporting payments.Maintaining diary follow up on all files to ensure prompt disposition.Ensuring that all claims files and company information are kept confidential.Identifying and following up on all salvage and subrogation opportunities promptly.Completing a level of investigation that is commensurate with the financial exposure on each loss handled.Managing files in accordance with established Best Practices.Obtaining and analyzing leases, contracts, by-laws and other relevant documents which may have an impact on the adjustment of losses.Establishing timely and accurate claim and expense reserves. Posts all reserves in system within Best Practice guidelines and updates system promptly as new information received:Posting all reserves in system within file standards guidelines and updates system promptly as new information received.Determining appropriate settlement amount based on independent judgment, computer assisted estimates, estimation of actual cash value and replacement value, appraisals, application of applicable limits and deductibles.Explaining payment amounts to all customers by email or letter.Referring all files above settlement authority, with recommendations for resolution, to Unit Manager and follows up through closure.Negotiating and conveying claim settlements within authority limits to insureds.Writing denial letters, Reservation of Rights and other complex correspondence to insureds.Controlling damages through proper usage of cost containment tools.Meeting all quality standards and expectations per file standard guidelines.Perform other duties as assigned.
What Will Our Ideal Candidate Have?
University Degree/College Diploma or equivalent business experience.Enrolment in the CIP program is an asset.High proficiency with Windows-based programs including spreadsheet and word-processing applications.Strong verbal and written communications skills. Ability to deal with people and communicate effectively by telephone.Ability to understand and apply policies and procedures.Proficiency in typing.Excellent organizational skills with ability to work independently.Solid analytical and decision making skills.Adjusters license as required, based on business needs.Customer service orientation; empathy.Demonstrated ownership attitude and customer centric response to all assigned tasks.Math skills.Excellent negotiation skills.Hardware and software skills to utilize and leverage claim and estimating technology.In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements. Generally, License(s) are required to be obtained within three months of starting the job.

What is a Must Have?
A minimum of one year previous work experience.Experience utilizing computer technology; such as Microsoft Office, e-mail, Web-enabled applications, and database software required.Ability to accurately compute a variety of numerical calculations required.Licensing Required: In order to perform the essential job functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with provincial and Travelers requirements.Must secure and maintain company credit card if required.

What Is in It for You?

Health Insurance: Employees and their eligible family members - including spouses, partners, and children - are eligible for coverage from the first day of employment.Retirement: Travelers provides a core contribution of 3% of your total eligible earnings to your Deferred Profit Sharing Plan (“DPSP”). Travelers also matches your savings plan contribution dollar-for-dollar up to 5% of base pay.Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off (“PTO”) annually, plus the opportunity to purchase additional days to allow for up to a total of 36 PTO days per year. You will also receive twelve paid company Holidays.Wellness Program: The Travelers wellness program is comprised of tools and resources that empower you to achieve your wellness goals. In addition, our Life Balance program provides access to professional counseling services and other resources to support your daily life needs. Through Life Balance, you're eligible for free counseling sessions with a licensed therapist.Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.Hybrid Work Arrangement: Employees in this position can split their time between working from home and a Travelers office.

Equal Employment Opportunity Statement
Travelers is an equal opportunity employer. We are committed to providing accommodation to persons with disabilities. If you require accommodation during the recruitment or interview process we will work with you to accommodate your needs.

If you are a candidate and have specific questions regarding the physical requirements of this role, please send us an email so we may assist you.
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Updated March 14, 2024

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.