Claims service representative vs claims representative

The differences between claims service representatives and claims representatives 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 representative takes usually requires 4-6 years. Additionally, a claims representative has an average salary of $38,796, which is higher than the $36,043 average annual salary of a claims service representative.

The top three skills for a claims service representative include insurance claims, customer service and policy coverage. The most important skills for a claims representative are customer service, quality standards, and policy coverage.

Claims service representative vs claims representative overview

	Claims Service Representative	Claims Representative
Yearly salary	$36,043	$38,796
Hourly rate	$17.33	$18.65
Growth rate	-4%	-6%
Number of jobs	127,339	18,565
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 62%
Average age	40	44
Years of experience	12	6

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 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.

Claims service representative vs claims representative salary

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

	Claims Service Representative	Claims Representative
Average salary	$36,043	$38,796
Salary range	Between $30,000 And $42,000	Between $28,000 And $53,000
Highest paying City	Urban Honolulu, HI	Dearborn, MI
Highest paying state	Alaska	New Jersey
Best paying company	Homeowners Choice	W. R. Berkley
Best paying industry	Government	Government

Differences between claims service representative and claims representative education

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

	Claims Service Representative	Claims Representative
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 62%
Most common major	Business	Business
Most common college	-	Stanford University

Claims service representative vs claims representative demographics

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

	Claims Service Representative	Claims Representative
Average age	40	44
Gender ratio	Male, 29.2% Female, 70.8%	Male, 37.5% Female, 62.5%
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, 11.0% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	10%

Differences between claims service representative and claims representative 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 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.

Claims service representative vs claims representative 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 representative skills

Customer Service, 26%
Quality Standards, 6%
Policy Coverage, 6%
Reservations, 5%
Claims Handling, 3%
Insurance Coverage, 3%

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Claims Service Representative
Claims Service Representative vs Claims Representative

Updated January 8, 2025

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