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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.

Here are examples of responsibilities from real claims representative resumes representing typical tasks they are likely to perform in their roles.

  • Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
  • Participate in catastrophe claims contact initiatives to provide superior customer service.
  • Assist the training department in developing CSR training in order to set expectations.
  • Communicate with customers and associates over the telephone, mobile app, click to chat, and internet reporting.
  • Input, track, and research member appeal requests in accordance with company as well as CMS policies and procedures.
  • Create custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
  • Call insurance companies for EOB explanation and/or reconciliation.
  • Utilize proper SIU reporting procedures for extensive investigation as required.
  • Process of professional and institutional claims according to CMS and Med-Cal/Medicare guidelines
  • Communicate with customers and associates over the telephone and internet reporting.
Claims Representative Traits
Analytical skills have to do with gathering information from various sources and then interpreting the data in order to reach a logical conclusion that benefits the business.
Detail oriented involves being extremely mindful and observant of all details.
Interpersonal skills involves being able to communicate efficiently with multiple people regarding your thoughts, ideas and feedback.

Claims Representative Overview

Between the years 2018 and 2028, claims representative jobs are expected to undergo a growth rate described as "decline" at -4%, according to the Bureau of Labor Statistics. So if the thought "should I become a claims representative?" Has crossed your mind, maybe you should take the growth rate into account. In addition, the number of claims representative opportunities that are projected to become available by 2028 is -13,000.

Claims representatives average about $17.91 an hour, which makes the claims representative annual salary $37,250. Additionally, claims representatives are known to earn anywhere from $26,000 to $51,000 a year. This means that the top-earning claims representatives make $25,000 more than the lowest earning ones.

It's hard work to become a claims representative, but even the most dedicated employees consider switching careers from time to time. Whether you're interested in a more challenging position or just looking for a fresh start, we've compiled extensive information on becoming a property adjuster, insurance adjuster, adjuster, and appraiser.

Claims Representative Jobs You Might Like

Claims Representative Skills and Personality Traits

We calculated that 20% of Claims Representatives are proficient in Customer Service, Communication, and Insurance Companies. They’re also known for soft skills such as Analytical skills, Detail oriented, and Interpersonal skills.

We break down the percentage of Claims Representatives that have these skills listed on their resume here:

  • Customer Service, 20%

    Provided optimum customer service to policyholders; daily correspondence by phone and/or mail to ensure complete and accurate information about claims.

  • Communication, 11%

    Recognized by management for the positive compliments received from customers for my communication skills and showing empathy while gathering initial statements.

  • Insurance Companies, 9%

    Managed the negotiation, arbitration, or litigation processes to recover damages from other insurance companies and uninsured motorists.

  • Policy Coverage, 5%

    Obtained facts to evaluate coverage, negligence, medical necessity and Causation/damages to make proper liability and policy coverage decisions.

  • Medical Records, 5%

    Analyzed medical bills and medical records determine motor vehicle injury association, coding and charge accuracy, and prepared payments accordingly.

  • Quality Standards, 5%

    Processed physician claims according to members Certificate of Coverage while meeting specific production and quality standards.

Most claims representatives list "customer service," "communication," and "insurance companies" as skills on their resumes. We go into more details on the most important claims representative responsibilities here:

  • The most important skills for a claims representative to have in this position are analytical skills. In this excerpt that we gathered from a claims representative resume, you'll understand why: "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay" According to resumes we found, analytical skills can be used by a claims representative in order to "resolved disputes between policy holders, claimants, and repair shops evaluated insurance policies and analyzed damages to determine coverage. "
  • While it may not be the most important skill, we found that many claims representative duties rely on detail oriented. This example from a claims representative explains why: "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." This resume example is just one of many ways claims representatives are able to utilize detail oriented: "detail logging of necessary information into customized software application trained new employees and mentored. "
  • Interpersonal skills is also an important skill for claims representatives to have. This example of how claims representatives use this skill comes from a claims representative resume, "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering" Read this excerpt from a resume to understand how vital it is to their everyday roles and responsibilities, "enhanced marketing and interpersonal skills by processing auto property damage claims and bodily injury claims. "
  • A thorough review of lots of resumes revealed to us that "math skills" is important to completing claims representative responsibilities. This resume example shows just one way claims representatives use this skill: "appraisers must be able to calculate property damage." Here's an example of how this skill is used from a resume that represents typical claims representative tasks: "analyzed national catastrophe claim and telephone call statistics to develop new staffing and scheduling model for national centralized catastrophe operation center. "
  • As part of the claims representative description, you might find that one of the skills that might be helpful to the job is "communication skills." A claims representative resume included this snippet: "claims adjusters and investigators must get information from a wide range of people, including claimants, witnesses, and medical experts" This skill could be useful in this scenario: "maintained high volume telephone communications with employers and employees of insurance company to investigate insurance position on claim determination and compensation. "
  • See the full list of claims representative skills.

    Before becoming a claims representative, 53.9% earned their bachelor's degree. When it comes down to graduating with a master's degree, 4.3% claims representatives went for the extra education. If you're wanting to pursue this career, it may be possible to be successful with a high school degree. In fact, most claims representatives have a college degree. But about one out of every six claims representatives didn't attend college at all.

    Those claims representatives who do attend college, typically earn either business degrees or criminal justice degrees. Less commonly earned degrees for claims representatives include psychology degrees or communication degrees.

    When you're ready to become a claims representative, you might wonder which companies hire claims representatives. According to our research through claims representative resumes, claims representatives are mostly hired by Travelers, Sedgwick, and Travelers Companies Foundation. Now is a good time to apply as Travelers has 155 claims representatives job openings, and there are 80 at Sedgwick and 62 at Travelers Companies Foundation.

    But if you're interested in companies where you might earn a high salary, claims representatives tend to earn the biggest salaries at Cognizant, Chubb, and Utica Mutual Insurance Company. Take Cognizant for example. The median claims representative salary is $47,150. At Chubb, claims representatives earn an average of $42,074, while the average at Utica Mutual Insurance Company is $41,570. You should take into consideration how difficult it might be to secure a job with one of these companies.

    View more details on claims representative salaries across the United States.

    We also looked into companies who hire claims representatives from the top 100 educational institutions in the U.S. The top three companies that hire the most from these institutions include State Farm, Progressive, and Nationwide Mutual Insurance ..

    The industries that claims representatives fulfill the most roles in are the insurance and professional industries. But the highest claims representative annual salary is in the agriculture industry, averaging $42,373. In the finance industry they make $39,975 and average about $39,834 in the insurance industry. In conclusion, claims representatives who work in the agriculture industry earn a 7.4% higher salary than claims representatives in the health care industry.

    The three companies that hire the most prestigious claims representatives are:

      What Property Adjusters Do

      Typically working for insurance companies, a property adjuster specializes in inspecting property damages to assess and determine a company's financial obligations. Their responsibilities revolve around reaching out to clients through calls and correspondence, arranging appointments, gathering and verifying data, and traveling to different locations to meet with clients. They may also negotiate settlements and authorize payments in adherence to the company's policies and regulations. Furthermore, as a property adjuster, it is essential to have a deep understanding of property costs to ensure the accuracy of claims.

      In this section, we take a look at the annual salaries of other professions. Take property adjuster for example. On average, the property adjusters annual salary is $4,455 higher than what claims representatives make on average every year.

      While the salaries between these two careers can be different, they do share some of the same responsibilities. Employees in both claims representatives and property adjusters positions are skilled in customer service, communication, and insurance companies.

      These skill sets are where the common ground ends though. A claims representative responsibility is more likely to require skills like "quality standards," "appropriate parties," "life insurance," and "process claims." Whereas a property adjuster requires skills like "adjusters," "claims process," "property losses," and "insurance policy." Just by understanding these different skills you can see how different these careers are.

      Property adjusters receive the highest salaries in the insurance industry coming in with an average yearly salary of $87,353. But claims representatives are paid more in the agriculture industry with an average salary of $42,373.

      The education levels that property adjusters earn is a bit different than that of claims representatives. In particular, property adjusters are 0.1% less likely to graduate with a Master's Degree than a claims representative. Additionally, they're 0.4% less likely to earn a Doctoral Degree.

      What Are The Duties Of an Insurance Adjuster?

      The next role we're going to look at is the insurance adjuster profession. Typically, this position earns a higher pay. In fact, they earn a $4,138 higher salary than claims representatives per year.

      A similarity between the two careers of claims representatives and insurance adjusters are a few of the skills associated with both roles. We used resumes from both professions to find that both use skills like "customer service," "communication," and "insurance companies. "

      While some skills are similar in these professions, other skills aren't so similar. For example, several resumes showed us that claims representative responsibilities requires skills like "quality standards," "appropriate parties," "external customers," and "state regulations." But an insurance adjuster might use skills, such as, "adjusters," "state farm insurance," "property loss," and "independent insurance."

      Insurance adjusters may earn a higher salary than claims representatives, but insurance adjusters earn the most pay in the insurance industry with an average salary of $79,343. On the other side of things, claims representatives receive higher paychecks in the agriculture industry where they earn an average of $42,373.

      On the topic of education, insurance adjusters earn similar levels of education than claims representatives. In general, they're 0.9% less likely to graduate with a Master's Degree and 0.4% more likely to earn a Doctoral Degree.

      How an Adjuster Compares

      An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud. They collect documents from different organizations, perform field research, and interview witnesses to verify the accuracy of claims statement.

      The adjuster profession generally makes a lower amount of money when compared to the average salary of claims representatives. The difference in salaries is adjusters making $1,661 lower than claims representatives.

      By looking over several claims representatives and adjusters resumes, we found that both roles utilize similar skills, such as "customer service," "insurance companies," and "policy coverage." But beyond that the careers look very different.

      As mentioned, these two careers differ between other skills that are required for performing the work exceedingly well. For example, gathering from claims representatives resumes, they are more likely to have skills like "communication," "quality standards," "necessary information," and "social security." But a adjuster might have skills like "adjusters," "repair estimates," "personal property," and "homeowner."

      Adjusters make a very good living in the insurance industry with an average annual salary of $59,990. Whereas claims representatives are paid the highest salary in the agriculture industry with the average being $42,373.

      Adjusters are known to earn similar educational levels when compared to claims representatives. Additionally, they're 0.9% less likely to graduate with a Master's Degree, and 0.4% less likely to earn a Doctoral Degree.

      Description Of an Appraiser

      An appraiser is someone who assesses the monetary value of a property such as an automobile, real property, and personal claim. His or her responsibilities include resolving disparities between a property's monetary values and preparing narrative reports for projects. The essential skills that an appraiser should possess to accomplish such responsibilities include a keen eye for details, strong communication, analytical, and problem-solving skills, and the ability to work under pressure. The education requirements for the job vary depending on the area of focus.

      Now, we'll look at appraisers, who generally average a lower pay when compared to claims representatives annual salary. In fact, the difference is about $3,313 per year.

      While their salaries may vary, claims representatives and appraisers both use similar skills to perform their jobs. Resumes from both professions include skills like "customer service," "insurance companies," and "repair facilities. "

      Even though a few skill sets overlap, there are some differences that are important to note. For one, a claims representative might have more use for skills like "communication," "policy coverage," "medical records," and "quality standards." Meanwhile, some appraisers might include skills like "appraisal reports," "mai," "market research," and "uniform standards" on their resume.

      Appraisers earn a higher salary in the insurance industry with an average of $49,571. Whereas, claims representatives earn the highest salary in the agriculture industry.

      The average resume of appraisers showed that they earn similar levels of education to claims representatives. So much so that the likelihood of them earning a Master's Degree is 2.3% more. Additionally, they're less likely to earn a Doctoral Degree by 0.6%.