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Telephone claims representative skills for your resume and career

Updated January 8, 2025
3 min read
Below we've compiled a list of the most critical telephone claims representative skills. We ranked the top skills for telephone claims representatives based on the percentage of resumes they appeared on. For example, 26.5% of telephone claims representative resumes contained pip as a skill. Continue reading to find out what skills a telephone claims representative needs to be successful in the workplace.

15 telephone claims representative skills for your resume and career

1. PIP

Here's how telephone claims representatives use pip:
  • Processed medical bill payments under PIP (Personal Injury Protection) for First Party Injuries.
  • Responded to PIP demands from medical providers and attorneys.

2. Litigation

Here's how telephone claims representatives use litigation:
  • Negotiated claim settlements and recommended litigation when settlements could not be negotiated.
  • Established and implemented appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.

3. Coverage Issues

Here's how telephone claims representatives use coverage issues:
  • Presented Regional Liability Administrators with compelling evidence to deny or disclaim files with coverage issues.
  • Investigated coverage issues, disputed liability claims and first-party injury claims.

4. Bodily Injury Claims

Here's how telephone claims representatives use bodily injury claims:
  • Negotiated settlements of bodily injury claims with attorneys as well as unrepresented claimants.
  • Negotiate effectively with unrepresented and represented parties to settle bodily injury claims.

5. 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 telephone claims representatives use customer service:
  • Communicated liability decisions to insureds and claimants while maintaining high levels of customer service.
  • Provided excellent customer service while offering customer solutions using in-depth product knowledge.

6. Process Claims

Process claims refers to the procedure an insurance agent follows once receiving a claim from an insured individual. This often includes reviewing, investigating, and deciding on whether the claim will be accepted or denied depending on the results of the insurer's investigation. This is a common procedure for all kinds of insurance including medical, auto, and liability insurance.

Here's how telephone claims representatives use process claims:
  • Pursued knowledge of state laws and policy contracts regarding both coverage and liability to properly process claims.
  • Analyzed claim files and insurance policies to process claims in accordance with individual coverage available.

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7. Medical Bills

Here's how telephone claims representatives use medical bills:
  • Handled first and third party medical claims to include the review and payment of medical bills to providers.
  • Handle first party injuries, analyzing medical bills and issuing timely payments.

8. Police Reports

Police reports, also known as "incident reports," are recorded by members of the police department and detail a (potentially) illegal incident or confrontation. The following information is usually found on a police report: the date and time of the incident, which officers were involved, the address of the incident, what kind of incident (theft, assault, etc.), and how the officers were alerted to the incident.

Here's how telephone claims representatives use police reports:
  • Garnered information from clients, police reports, interviews, photos, satellite imagery, eyewitness, and driver accounts.
  • Investigated liability insurance claims through the use of recorded statements, police reports, and other pertinent documents.

9. Auto Insurance Claims

Here's how telephone claims representatives use auto insurance claims:
  • Conducted coverage investigations and investigations of fraudulent auto insurance claims.

10. Arbitration

Here's how telephone claims representatives use arbitration:
  • Negotiated liability with other insurance companies when possible, reviewed files and documents for arbitration process.
  • Drafted contentions for arbitration and submitted evidence to support those contentions.

11. 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 telephone claims representatives use policy coverage:
  • Conducted necessary investigations to determine policy coverage and details of the loss by telephone.
  • Conducted investigations of automobile accidents involving bodily injury and property damage to determine fault, liability and policy coverage and limits.

12. Claims Handling

Here's how telephone claims representatives use claims handling:
  • Facilitated a training class of 20 new hires making them aware of the claims handling process.
  • Meet the demanding deadlines based off the company and state regulated standard for good claims handling.

13. Policy Contract

Here's how telephone claims representatives use policy contract:
  • Maintained auto accident files and monitored auto policy contracts.
  • Obtained licenses in multiple states and interpreted various policy contracts to afford available coverage

14. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how telephone claims representatives use cpt:
  • Make complex eligibility determinations regarding payment of claims based on CPT methodology, ICD-9 protocol and information found in appropriate.
  • Trained new claims processors in ICD-9 and CPT coding effectiveness, adjusting, and paying health insurance claims for various Contracts.

15. Policy Holders

Here's how telephone claims representatives use policy holders:
  • Handled incoming calls from policy holders and claimants involved in comparative negligent losses.
  • process initial claim report for policy holders and claimants, follow-up for all claim reports
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List of telephone claims representative skills to add to your resume

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

  • PIP
  • Litigation
  • Coverage Issues
  • Bodily Injury Claims
  • Customer Service
  • Process Claims
  • Medical Bills
  • Police Reports
  • Auto Insurance Claims
  • Arbitration
  • Policy Coverage
  • Claims Handling
  • Policy Contract
  • CPT
  • Policy Holders
  • Property Damage Claims
  • Liability Disputes
  • Insurance Coverage
  • Inbound Calls
  • Insurance Policies
  • Insurance Carriers
  • State Laws
  • Liability Investigations
  • Law Enforcement
  • Liability Decisions
  • Gathering Evidence
  • Coverage Investigations
  • Liability Claims
  • Body Shop

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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