Post job

Claims service representative vs customer service representative

The differences between claims service representatives and customer service representatives can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a claims service representative and a customer service representative. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $32,260 average annual salary of a customer 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 customer service representative are cleanliness, POS, and data entry.

Claims service representative vs customer service representative overview

Claims Service RepresentativeCustomer Service Representative
Yearly salary$36,043$32,260
Hourly rate$17.33$15.51
Growth rate-4%-4%
Number of jobs127,339209,515
Job satisfaction-4
Most common degreeBachelor's Degree, 52%High School Diploma, 33%
Average age4040
Years of experience1212

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 customer service representative do?

Customer service representatives are the first point of contact of the customers, acting as the frontiers of the company and help in driving customer loyalty and retention by leaving a great impression and resolving all of their concerns. They accommodate customer queries by providing useful and comprehensive information about any products or services. Some would use that as an opportunity to market and promote more sales. The most challenging issues they use to handle are customer complaints and processing of refunds and returns. They also assist in basic troubleshooting or accounts and payment setup with the use of specific guidelines or step by step procedures. At most, they help and solve customer issues on their own, but sometimes they would need support from supervisors or other departments.

Claims service representative vs customer service representative salary

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

Claims Service RepresentativeCustomer Service Representative
Average salary$36,043$32,260
Salary rangeBetween $30,000 And $42,000Between $25,000 And $41,000
Highest paying CityUrban Honolulu, HIDes Moines, WA
Highest paying stateAlaskaWashington
Best paying companyHomeowners ChoiceOracle
Best paying industryGovernmentInsurance

Differences between claims service representative and customer service representative education

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

Claims Service RepresentativeCustomer Service Representative
Most common degreeBachelor's Degree, 52%High School Diploma, 33%
Most common majorBusinessBusiness
Most common college--

Claims service representative vs customer service representative demographics

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

Claims Service RepresentativeCustomer Service Representative
Average age4040
Gender ratioMale, 29.2% Female, 70.8%Male, 30.5% Female, 69.5%
Race ratioBlack 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, 11.6% Unknown, 5.2% Hispanic or Latino, 21.2% Asian, 6.3% White, 55.0% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between claims service representative and customer service 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.
  • Show more

Customer service representative example responsibilities.

  • Manage and plan escalations; assure HIPPA guidelines are followed for confidentially and privacy.
  • Maintain cleanliness and safety and assist patients as necessary.
  • Operate POS system and maintain exceptional and consistent customer service.
  • Exercise proofreading and basic math skills to maintain quality control over documents process
  • Work in customer service department entering information into customer relationship management (CRM).
  • Develop highly empathetic client relationships and earn reputation for exceeding good customer service rep goals.
  • Show more

Claims service representative vs customer service 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 customer service representative skills
  • Cleanliness, 10%
  • POS, 7%
  • Data Entry, 6%
  • Sales Floor, 6%
  • Customer Service, 5%
  • Home Health, 5%

Browse office and administrative jobs