Claims service representative vs enrollment representative

The differences between claims service representatives and enrollment 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 an enrollment representative. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $31,463 average annual salary of an enrollment representative.

The top three skills for a claims service representative include insurance claims, customer service and policy coverage. The most important skills for an enrollment representative are home health, customer service, and data entry.

Claims service representative vs enrollment representative overview

	Claims Service Representative	Enrollment Representative
Yearly salary	$36,043	$31,463
Hourly rate	$17.33	$15.13
Growth rate	-4%	-4%
Number of jobs	127,339	185,567
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 52%
Average age	40	40
Years of experience	12	12

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 an enrollment representative do?

An enrollment representative directly communicates with clients when it comes to enrollment programs. Although their duties vary on their place or industry of employment, it typically includes helping enrollees understand the program requirements and rules, reaching out to enrollees to provide updates, gathering and processing applications, answering inquiries, and collecting payments when necessary. They also perform clerical tasks such as preparing and processing documents, updating databases, and maintaining records. Moreover, an enrollment representative must maintain an active communication line with staff for a smooth and efficient workflow.

Claims service representative vs enrollment representative salary

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

	Claims Service Representative	Enrollment Representative
Average salary	$36,043	$31,463
Salary range	Between $30,000 And $42,000	Between $25,000 And $38,000
Highest paying City	Urban Honolulu, HI	Temecula, CA
Highest paying state	Alaska	California
Best paying company	Homeowners Choice	Curry College
Best paying industry	Government	Non Profits

Differences between claims service representative and enrollment representative education

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

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

Claims service representative vs enrollment representative demographics

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

	Claims Service Representative	Enrollment Representative
Average age	40	40
Gender ratio	Male, 29.2% Female, 70.8%	Male, 29.1% Female, 70.9%
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, 9.6% Unknown, 5.4% Hispanic or Latino, 21.8% Asian, 6.6% White, 55.9% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between claims service representative and enrollment 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.

Enrollment representative example responsibilities.

Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
Audit all tickets for proper labs, correct ICD-9 coding and CPT coding.
Learned ICD-9 codes and medical billing to insure prompt and accurate processing of claims.
Resolve claims by verifying CPT and ICD-9 coding and the expected reimbursement per contractual agreements with varying insurance providers.
Proofread any errors than may occur, fax, file, track all PCP forms
Adhere to all key audit controls and comply with all establish standards associate with HIPAA, SOX and SAS70.

Claims service representative vs enrollment 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 enrollment representative skills

Home Health, 22%
Customer Service, 18%
Data Entry, 10%
Patients, 6%
CMS, 4%
Enrollment Process, 4%

Claims Service Representative vs. similar jobs

Claims Service Representative related careers

Claims Service Representative related jobs

What similar roles do

Zippia Careers
Office and Administrative Industry
Claims Service Representative
Claims Service Representative vs Enrollment Representative

Updated January 8, 2025

Browse office and administrative jobs