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Claims service representative skills for your resume and career

Updated January 8, 2025
3 min read
Claims service representative example skills
Below we've compiled a list of the most critical claims service representative skills. We ranked the top skills for claims service representatives based on the percentage of resumes they appeared on. For example, 12.3% of claims service representative resumes contained insurance claims as a skill. Continue reading to find out what skills a claims service representative needs to be successful in the workplace.

15 claims service representative skills for your resume and career

1. Insurance Claims

Here's how claims service representatives use insurance claims:
  • Assisted medical review department with provider and member authorization requests and appeals for health insurance claims processing.
  • Specialized in personal automobile insurance claims.

2. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims service representatives use customer service:
  • Utilized numerous computer systems simultaneously to provide quick and efficient service, while maintaining an above average customer service rating score.
  • Trained claims examiners and customer service representatives how to navigate the system and apply departmental policies and procedures.

3. Policy Coverage

Policy coverage is an agreement between a person and an insurer outlining the coverage - what is covered, what is not, and other details of the agreement. Policy coverage is typically a combination of several standard forms, including a declaration page, coverage form, and endorsements. These forms delineate the coverage term, the policy limits, the grant of coverage, exclusions and other limitations of coverage, and the duties and responsibilities of the insured in the event of a loss.

Here's how claims service representatives use policy coverage:
  • Verified accident facts and reviewed policy coverage to determine legal liability of automobile claims.
  • Verified accident facts and determine policy coverage and reviewed and settled undisputed non-injury claims.

4. Phone Calls

Phone calls are a wireless or wired connection made over a telephone or a mobile phone between two people. Two parties are involved in a phone call, the caller and the receiver. A caller dials the number of the one he wants to call, and the recipient hears a bell or a tune to which he picks up the call. The call establishes a connection between them through which they can communicate. The voice is converted into signals and is transmitted through wired or wireless technology.

Here's how claims service representatives use phone calls:
  • Serviced telephone calls and written correspondence received from providers and members.
  • Answered inbound phone calls in a call center environment from policyholders, attorney's offices, medical providers and body shops.

5. Claims Process

Here's how claims service representatives use claims process:
  • Provided administrative and supervisory support to the Claims Processing Supervisor.
  • Commended for claims processing efficiency.

6. Inbound Calls

Here's how claims service representatives use inbound calls:
  • Handled inbound calls from policyholders and claimants reporting accidents, completed initial reports, and ensuring rapid and fair claim handling.
  • Answered inbound calls attending to clients who were placing a claim to their home owner's insurance.

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7. Auto Accidents

Here's how claims service representatives use auto accidents:
  • Documented and recorded initial reports of auto accidents and property damage from 1st and 3rd parties.
  • Handle first contact for first and third party customers with regards to auto accidents.

8. Body Shop

A body shop is a place where vehicle servicing, repairing, and finishing takes place. Auto mechanics and technicians do the repairs. The services offered include both body and mechanical repairs. Body repairs include repainting and removing dents and scratches. Mechanical repairs include changing and alignment of car tires, engine repair, replacing windshields and window glasses.

Here's how claims service representatives use body shop:
  • Interview and interact with policyholders, claimants, medical insurers, medical providers, attorneys and body shops to resolve claims.
  • Coordinate with the client, appraiser, vehicle owner, and body shop to move the claim files forward towards resolution.

9. Strong Customer Service

Here's how claims service representatives use strong customer service:
  • Demonstrate strong customer service and communication skills and adhere to HIPPA and patient confidentiality requirements.
  • Provided account and data analysis to support delivery of strong customer service focus.

10. CSR

Here's how claims service representatives use csr:
  • Created custom templates and guide sheets for new trainees in the CSR Internet division to ensure consistency and increase department efficiency.
  • Awarded CSR of the Year for consistently performing at a higher level and going beyond job requirements.

11. Party Claims

Here's how claims service representatives use party claims:
  • Maintain level of confidence with workers' compensation laws, 3RD party claims in the 48 states.
  • Handled 3rd party claims administration throughout the state of Florida on behalf of multiple insurance companies.

12. Claims Adjusters

Here's how claims service representatives use claims adjusters:
  • General Liability Claims Supervisor Supervising a general liability unit comprised of 5 claims adjusters along with one claims staff assistant.
  • Refer questionable claims to investigators or senior claims adjusters for further investigation or settlement.

13. Policy Holders

Here's how claims service representatives use policy holders:
  • Evaluated insurance contracts with policy holders to determine appropriate coverage and benefits.
  • Communicate respectfully and professionally with policy holders and Nationwide associates.

14. Medical Claims

Here's how claims service representatives use medical claims:
  • Process institutional claims for Traditional and Comprehensive Medical coverage, and Major Medical claims.
  • Processed medical claims and Workers Compensation according to plan provisions on traditional accounts.

15. Outbound Calls

An outbound call is made by the call center representative to the customers on behalf of the company. Such calls help increase sales and generate revenue for the organization.

Here's how claims service representatives use outbound calls:
  • Directed inbound/outbound calls and assisted customers with specific inquiries for dental and medical policies.
  • Updated all contact info, gathered statements, set rentals and made outbound calls to involved parties with the claim.
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List of claims service representative skills to add to your resume

Claims service representative skills

The most important skills for a claims service representative resume and required skills for a claims service representative to have include:

  • Insurance Claims
  • Customer Service
  • Policy Coverage
  • Phone Calls
  • Claims Process
  • Inbound Calls
  • Auto Accidents
  • Body Shop
  • Strong Customer Service
  • CSR
  • Party Claims
  • Claims Adjusters
  • Policy Holders
  • Medical Claims
  • Outbound Calls
  • Liability Claims
  • Insurance Policies
  • Liability Decisions
  • Police Reports
  • Claims Handling
  • Automobile Claims
  • Insurance Coverage
  • Customer Calls
  • Claims Issues
  • Computer System
  • Customer Inquiries
  • CPT
  • Medical Bills
  • Inquiry Calls
  • Arbitration
  • Telephone Calls
  • Repair Shops
  • Coverage Issues
  • Insurance Carriers
  • Compensation Claims
  • Medicaid
  • Telephone Inquiries
  • Quality Standards
  • Property Damage Claims
  • ICD-9
  • Bodily Injury Claims
  • Rental Reservations
  • Issue Payments
  • Policy Contract
  • Commercial Property
  • Medical Reports
  • Geico
  • Fraudulent Claims

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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