Claims service representative vs member service representative

The differences between claims service representatives and member 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 member service representative. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $31,395 average annual salary of a member 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 member service representative are front desk, cleanliness, and punctuality.

Claims service representative vs member service representative overview

	Claims Service Representative	Member Service Representative
Yearly salary	$36,043	$31,395
Hourly rate	$17.33	$15.09
Growth rate	-4%	-4%
Number of jobs	127,339	214,036
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 44%
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 a member service representative do?

A member service representative is responsible for providing customer service support to an organization. Member service representatives' duties include responding to customer's inquiries and complaints, developing effective sales pitches, processing customer's requests and orders, creating reports, developing recommendations to improve the operation's performance, and escalating high-level concerns. A member service representative should maintain excellent customer service, as well as excellent time-management skills and the ability to multi-task, to work under pressure, and assist customers under minimal supervision.

Claims service representative vs member service representative salary

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

	Claims Service Representative	Member Service Representative
Average salary	$36,043	$31,395
Salary range	Between $30,000 And $42,000	Between $21,000 And $45,000
Highest paying City	Urban Honolulu, HI	Alameda, CA
Highest paying state	Alaska	Hawaii
Best paying company	Homeowners Choice	Tinker Federal Credit Union
Best paying industry	Government	Insurance

Differences between claims service representative and member service representative education

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

	Claims Service Representative	Member Service Representative
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 44%
Most common major	Business	Business
Most common college	-	-

Claims service representative vs member service representative demographics

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

	Claims Service Representative	Member Service Representative
Average age	40	40
Gender ratio	Male, 29.2% Female, 70.8%	Male, 26.5% Female, 73.5%
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, 10.7% Unknown, 5.4% Hispanic or Latino, 22.1% Asian, 6.7% White, 54.4% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between claims service representative and member 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.

Member service representative example responsibilities.

Coordinate and manage ATM and automate telephone services.
Identify cross-sell opportunities; actively and aggressively promote products to achieve credit union target production expectations.
Utilize federal and state Medicaid health guidelines to implement proper manage care according to departmental policies and procedures.
Educate veterans and the college community on veteran's benefits and academic requirements need to accomplish academic goals.
Open different accounts base on customer needs, from basic checking and savings, to IRAs, Cds, etc.
Train in CPR and other emergency procedures.

Claims service representative vs member 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 member service representative skills

Front Desk, 29%
Cleanliness, 24%
Punctuality, 8%
Loan Payments, 3%
Member Service, 3%
Phone Calls, 2%

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Office and Administrative Industry
Claims Service Representative
Claims Service Representative vs Member Service Representative

Updated January 8, 2025

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