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Claims representative skills for your resume and career

Updated January 8, 2025
4 min read
Claims representative example skills
Below we've compiled a list of the most critical claims representative skills. We ranked the top skills for claims representatives based on the percentage of resumes they appeared on. For example, 25.9% of claims representative resumes contained customer service as a skill. Continue reading to find out what skills a claims representative needs to be successful in the workplace.

15 claims representative skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims representatives use customer service:
  • Provided optimum customer service to policyholders; daily correspondence by phone and/or mail to ensure complete and accurate information about claims.
  • Investigated coverage, determined liability, assessed damages and managed rental vehicles while maintaining quality metric scores and outstanding customer service.

2. Quality Standards

Quality standards are a specific level of standards of products that are set by the companies for the customers that have to be met and maintained throughout the process until the time of delivery. Quality standards are information that includes the customer's requirements, guidelines, and characteristics for the needed final product or service.

Here's how claims representatives use quality standards:
  • Processed physician claims according to members Certificate of Coverage while meeting specific production and quality standards.
  • Directed and coordinated daily operational activities to ensure adherence to quality standards, deadlines and procedures.

3. Policy Coverage

Policy coverage is an agreement between a person and an insurer outlining the coverage - what is covered, what is not, and other details of the agreement. Policy coverage is typically a combination of several standard forms, including a declaration page, coverage form, and endorsements. These forms delineate the coverage term, the policy limits, the grant of coverage, exclusions and other limitations of coverage, and the duties and responsibilities of the insured in the event of a loss.

Here's how claims representatives use policy coverage:
  • Obtained facts to evaluate coverage, negligence, medical necessity and Causation/damages to make proper liability and policy coverage decisions.
  • Verify assigned claims validity, policy coverage, limits, determine damages and providing information to customers for timely settlement.

4. Reservations

Here's how claims representatives use reservations:
  • Composed professional communications including reservations of rights, status, settlement and declination letters.
  • Analyze bodily injury, obtain medical bills *Set up rental reservations for insured/claimant.

5. Claims Handling

Here's how claims representatives use claims handling:
  • Provided training on claims processes and successful customer relationship management skills, promoted adherence to internal and state-regulated claims handling standards.
  • Managed all aspects of claims handling including liability decisions, customer service, financial indemnification and identification of fraudulent claims.

6. Insurance Coverage

Here's how claims representatives use insurance coverage:
  • Responded courteously and accurately to all phone inquiries regarding verification of members' insurance coverage, eligibility and claim status.
  • Analyzed and interpreted extensive medical data and examined claim forms to determine insurance coverage.

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7. State Regulations

State regulations are the rules made by the state authorities under a specific Act. When a government intervenes in the private market to implements policies, they are known as state regulations. These policies help in achieving the economic, political, and social targets which might not be able to achieve otherwise.

Here's how claims representatives use state regulations:
  • Analyze and investigate claims to make coverage decisions and negotiate settlements with insureds in accordance with policy provisions and state regulations.
  • Provided information to customers regarding state regulations and policy provisions, and negotiated effectively with contractors hired to mitigate damages.

8. Insurance Policies

Here's how claims representatives use insurance policies:
  • Provided customers with information regarding existing property and casualty insurance policies involving workers compensation, automobile and general liability claims.
  • Researched and analyzed complex coverage issues in order to verify the accuracy and liability of various automobile insurance policies.

9. Xactimate

Xactimate is a computer platform used to estimate the cost of room restoration. Users sketch an architectural outline of the room, which offers a close estimation for project costs. Xactimate can connect to the cloud so these plans and estimates can be accessed anywhere on mobile and desktop devices.

Here's how claims representatives use xactimate:
  • Completed field inspection of losses including accurate scope of damages, photographic evidence collection, written estimates utilizing Xactimate estimating software.
  • Investigated, evaluated, and managed call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.

10. Medical Terminology

Here's how claims representatives use medical terminology:
  • Developed veterans' compensation and/or pension claims, which incorporated medical terminology and awareness of recent legislation.
  • Entered claims data into system while interpreting coding and medical terminology in relation to diagnosis and procedures.

11. Auto Claims

Auto claims are claims made to insurance companies or firms in cases of accidents, collisions, or damages to determine payments made. Insurance companies hire auto claim adjusters to help inspect, assess, and determine the state of damager on an auto vehicle and the costs that would incur.

Here's how claims representatives use auto claims:
  • Handled all aspects of auto claims including thorough liability investigations and negotiation of injury claims at a non-standard auto insurance company.
  • Investigated and processed auto claims in accordance with company claims procedures and legislative/regulatory requirements via telephone contact or correspondence.

12. Process Claims

Process claims refers to the procedure an insurance agent follows once receiving a claim from an insured individual. This often includes reviewing, investigating, and deciding on whether the claim will be accepted or denied depending on the results of the insurer's investigation. This is a common procedure for all kinds of insurance including medical, auto, and liability insurance.

Here's how claims representatives use process claims:
  • Communicated directly with facilities, physicians, and hospitals to obtain information needed to accurately process claims.
  • Determine liability and exposures on low complexity losses based on information gathered and process claims accordingly.

13. Insurance Claims

Here's how claims representatives use insurance claims:
  • Reviewed and managed insurance claims with responsibility for interaction with policyholders in the Hudson Valley region.
  • Retrieve information involving welfare, unemployment, workers compensation, disability or insurance claims.

14. Litigation

Here's how claims representatives use litigation:
  • Prepared necessary state filings within statutory limits, managed litigation and vocational rehabilitation process, used appropriate cost containment techniques.
  • Handled claims involving first party and/or third party litigation, including complex/non-routine lawsuits, alternative dispute resolution and extra-contractual damages.

15. Medical Claims

Here's how claims representatives use medical claims:
  • Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and medical claims.
  • Specialized in Personal Injury Protection medical claims for customers while providing confidential, knowledgeable and fast customer care service.
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List of claims representative skills to add to your resume

The most important skills for a claims representative resume and required skills for a claims representative to have include:

  • Customer Service
  • Quality Standards
  • Policy Coverage
  • Reservations
  • Claims Handling
  • Insurance Coverage
  • State Regulations
  • Insurance Policies
  • Xactimate
  • Medical Terminology
  • Auto Claims
  • Process Claims
  • Insurance Claims
  • Litigation
  • Medical Claims
  • Social Security
  • Arbitration
  • Insurance Carriers
  • Bodily Injury Claims
  • Legal Liability
  • Casualty Claims
  • Repair Facilities
  • Computer System
  • Coverage Issues
  • SIU
  • Police Reports
  • Workers Compensation Claims
  • Inbound Calls
  • PIP
  • Medical Treatment
  • Medical Bills
  • Physical Damage
  • Medicaid
  • CPT
  • Policy Language
  • Party Claims
  • Outbound Calls
  • Strong Negotiation
  • HIPAA
  • Repair Shops
  • Property Damage Claims
  • Customer Inquiries
  • Policy Holders
  • State Laws
  • Commercial Property
  • Policy Provisions
  • Defense Counsel
  • Excellent Negotiation

Updated January 8, 2025

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.

Updated January 8, 2025

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