Claims service representative vs claims clerk

The differences between claims service representatives and claims clerks can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 6-12 months to become a claims service representative, becoming a claims clerk takes usually requires 2-4 years. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $32,815 average annual salary of a claims clerk.

The top three skills for a claims service representative include insurance claims, customer service and policy coverage. The most important skills for a claims clerk are data entry, customer service, and clerical support.

Claims service representative vs claims clerk overview

	Claims Service Representative	Claims Clerk
Yearly salary	$36,043	$32,815
Hourly rate	$17.33	$15.78
Growth rate	-4%	-3%
Number of jobs	127,339	78,588
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 31%
Average age	40	44
Years of experience	12	4

What does a claims service representative do?

Claims service representatives evaluate customer insurance claims. Their tasks in this career include interviewing witnesses or customers and visiting accident sites to assess the scope of the claim. Also, they determine whether it is worth arranging a settlement and make sure all settlement claims are managed quickly. In addition to evaluating accidents and claims, they renew customer policies based on their history. Qualifications for the job include a firm knowledge of overall company policy, computer literacy, and excellent customer service.

What does a claims clerk do?

Claims clerks review the forms and documents for insurance claims to check for missing information and attachments. The data they obtain is entered into their database for safekeeping and quick retrieval. They should know the answers to their clients' questions about the regulations, policies, and procedures covered by their insurance policy. These clerks prepare documents that their agents use to present to their clients. When working for this position, a person must have the ability to communicate well and be familiar with computer applications.

Claims service representative vs claims clerk salary

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

	Claims Service Representative	Claims Clerk
Average salary	$36,043	$32,815
Salary range	Between $30,000 And $42,000	Between $27,000 And $39,000
Highest paying City	Urban Honolulu, HI	-
Highest paying state	Alaska	-
Best paying company	Homeowners Choice	-
Best paying industry	Government	-

Differences between claims service representative and claims clerk education

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

	Claims Service Representative	Claims Clerk
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 31%
Most common major	Business	Business
Most common college	-	-

Claims service representative vs claims clerk demographics

Here are the differences between claims service representatives' and claims clerks' demographics:

	Claims Service Representative	Claims Clerk
Average age	40	44
Gender ratio	Male, 29.2% Female, 70.8%	Male, 17.5% Female, 82.5%
Race ratio	Black or African American, 12.8% Unknown, 5.2% Hispanic or Latino, 19.9% Asian, 6.1% White, 55.3% American Indian and Alaska Native, 0.7%	Black or African American, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	11%

Differences between claims service representative and claims clerk duties and responsibilities

Claims service representative example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Experience in medical terminology, ICD9, CPT and DRG coding.
Review types of service on claims base on the CPT codes and diagnosis code.
Examine injure persons and administer first aid or cardiopulmonary resuscitation, if necessary, using training and medical supplies and equipment.
Coordinate EDI traffic with external clearinghouses and business partner Multiplan.
Process EDI reports, purge reports, and smart data reject list.

Claims clerk example responsibilities.

Manage adding and removing vendors through claims automate system to ensure they are in compliance with IRS regulations.
File commercial, worker's comp, Medicare, and Medicaid claims to insurance carriers and employers.
Open and sort mail by claim types (HCPA UB 92 and T18).
Process medical HMO claims, POS claims, PPO claims and fee for service claims.
Review, scan, and file HCFA forms
Audit paper claims for accuracy in CPT and ICD9 codes.

Claims service representative vs claims clerk skills

Common claims service representative skills

Insurance Claims, 12%
Customer Service, 11%
Policy Coverage, 8%
Phone Calls, 7%
Claims Process, 6%
Inbound Calls, 4%

Common claims clerk skills

Data Entry, 26%
Customer Service, 9%
Clerical Support, 7%
Computer System, 5%
Medical Claims, 4%
Process Claims, 4%

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Claims Service Representative
Claims Service Representative vs Claims Clerk

Updated January 8, 2025

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