Claims service representative vs representative

The differences between claims service representatives and 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 representative. Additionally, a claims service representative has an average salary of $36,043, which is higher than the $36,023 average annual salary of a representative.

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

Claims service representative vs representative overview

	Claims Service Representative	Representative
Yearly salary	$36,043	$36,023
Hourly rate	$17.33	$17.32
Growth rate	-4%	-4%
Number of jobs	127,339	252,761
Job satisfaction	-	5
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 53%
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 representative do?

Representatives are lawmakers who represent the people in a specific district. They run for office to represent their districts in their hometown or their current place of living. Representatives are usually charismatic and good communicators. These characteristics are especially important during campaign and election periods. Representatives should be able to capture the hearts of the voters through their planned projects and advocacies. They are then elected by their constituents. Upon election, representatives author bills that will eventually be passed into law should it be approved by the majority of the congress. They also vote on the passage of bills authored by other representatives. They also participate in discussions and debates regarding different bills, issues, and laws. Representatives are expected to vote according to their conscience and in consideration of the voice of their constituents.

Claims service representative vs representative salary

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

	Claims Service Representative	Representative
Average salary	$36,043	$36,023
Salary range	Between $30,000 And $42,000	Between $23,000 And $55,000
Highest paying City	Urban Honolulu, HI	Washington, DC
Highest paying state	Alaska	New York
Best paying company	Homeowners Choice	Google
Best paying industry	Government	Transportation

Differences between claims service representative and representative education

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

	Claims Service Representative	Representative
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 53%
Most common major	Business	Business
Most common college	-	-

Claims service representative vs representative demographics

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

	Claims Service Representative	Representative
Average age	40	40
Gender ratio	Male, 29.2% Female, 70.8%	Male, 41.8% Female, 58.2%
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, 5.4% Hispanic or Latino, 20.9% Asian, 7.5% White, 54.4% American Indian and Alaska Native, 0.7%
LGBT Percentage	7%	7%

Differences between claims service representative and 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.

Representative example responsibilities.

Manage fitting rooms and recover the department, while providing exceptional customer service and offering rewards and POS options.
Manage physical portfolio with necessary derivatives to mitigate risk within company guidelines.
Conduct telephone sales and interviews, compile and enter information into database, manage documents and insure customer satisfaction.
Review EOB denials, appeals and/or rebilling as appropriate.
Certify of all requirements, policies, and procedures, including MSB.
Take inbound phone calls from member and providers explaining the EOB denial and payments

Claims service representative vs 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 representative skills

Cleanliness, 20%
Patients, 11%
Customer Issues, 10%
Customer Service, 10%
Data Entry, 6%
Outbound Calls, 3%

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Claims Service Representative
Claims Service Representative vs Representative

Updated January 8, 2025

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