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Career profile Insurance Claims Representative

Also known as Claim Processing Specialist, Claims Clerk, Claims Customer Service Representative (Claims CSR), Claims Processor, Claims Representative, Enrollment Representative, Insurance Analyst, Policy Service Coordinator, Policy Services Representative, Processing Clerk

Insurance Claims Representative

Also known as Claim Processing Specialist, Claims Clerk, Claims Customer Service Representative (Claims CSR)

Interests Profile
  • Conventional
  • Enterprising
  • Social
Pay Range
$29,480 - $64,460 (annual)
Required Skills
  • Active Listening
  • Reading Comprehension
  • Speaking
Knowledge Areas
  • Customer and Personal Service
  • Administrative
  • Computers and Electronics
Core tasks
  • Calculate premiums, refunds, commissions, adjustments, or new reserve requirements, using insurance rate standards.
  • Organize or work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.
  • Modify, update, or process existing policies and claims to reflect any change in beneficiary, amount of coverage, or type of insurance.
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What does an Insurance Claims Representative do?

Insurance Claims Representatives process new insurance policies, modifications to existing policies, and claims forms.

In addition, Insurance Claims Representatives

  • obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records,
  • update existing policies and company records to reflect changes requested by policyholders and insurance company representatives.

What kind of tasks does an Insurance Claims Representative perform regularly?

Insurance Claims Representatives are often responsible for overseeing or executing some or all of the following tasks:

  • Prepare insurance claim forms or related documents, and review them for completeness.
  • Calculate amount of claim.
  • Post or attach information to claim file.
  • Transmit claims for payment or further investigation.
  • Review insurance policy to determine coverage.
  • Contact insured or other involved persons to obtain missing information.
  • Process and record new insurance policies and claims.
  • Organize or work with detailed office or warehouse records, maintaining files for each policyholder, including policies that are to be reinstated or cancelled.
  • Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
  • Correspond with insured or agent to obtain information or to inform them of account status or changes.
  • Review and verify data, such as age, name, address, and principal sum and value of property, on insurance applications and policies.
  • Compare information from application to criteria for policy reinstatement, and approve reinstatement when criteria are met.
  • Examine letters from policyholders or agents, original insurance applications, and other company documents to determine if changes are needed and effects of changes.
  • Transcribe data to worksheets, and enter data into computer for use in preparing documents and adjusting accounts.
  • Notify insurance agent and accounting department of policy cancellation.

The above responsibilities are specific to Insurance Claims Representatives. More generally, Insurance Claims Representatives are involved in several broader types of activities:

Working with Computers
Using computers and computer systems (including hardware and software) to program, write software, set up functions, enter data, or process information.
Getting Information
Observing, receiving, and otherwise obtaining information from all relevant sources.
Communicating with Supervisors, Peers, or Subordinates
Providing information to supervisors, co-workers, and subordinates by telephone, in written form, e-mail, or in person.
Processing Information
Compiling, coding, categorizing, calculating, tabulating, auditing, or verifying information or data.
Evaluating Information to Determine Compliance with Standards
Using relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.

What is an Insurance Claims Representative salary?

The median salary for an Insurance Claims Representative is $42,050, and the average salary is $45,070. Both the median and average roughly describe the middle of the Insurance Claims Representative salary range, but the average is more easily affected by extremely high or low salaries.

Many Insurance Claims Representatives earn significantly more or less than the average, due to several factors. About 10% of Insurance Claims Representatives earn less than $29,480 per year, 25% earn less than $35,050, 75% earn less than $52,150, and 90% earn less than $64,460.

Between the years of 2020 and 2030, the number of Insurance Claims Representatives is expected to change by 1.4%, and there should be roughly 26,700 open positions for Insurance Claims Representatives every year.

Median annual salary
$42,050
Typical salary range
$29,480 - $64,460
Projected growth (2020 - 2030)
1.4%

What personality traits are common among Insurance Claims Representatives?

Interests

Career interests describe a person's preferences for different types of working environments and activities. When a person's interest match the demands of an occupation, people are usually more engaged and satisfied in that role.

Compared to most occupations, those who work as an Insurance Claims Representative are usually higher in their Conventional and Enterprising interests.

Insurance Claims Representatives typically have very strong Conventional interests. Conventional occupations frequently involve following set procedures and routines. These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow.

Also, Insurance Claims Representatives typically have moderate Enterprising interests. Enterprising occupations frequently involve starting up and carrying out projects. These occupations can involve leading people and making many decisions. Sometimes they require risk taking and often deal with business.

Values

People differ in their values, or what is most important to them for building job satisfaction and fulfillment.

Compared to most people, those working as an Insurance Claims Representative tend to value Relationships, Support, and Independence.

Most importantly, Insurance Claims Representatives moderately value Relationships. Occupations that satisfy this work value allow employees to provide service to others and work with co-workers in a friendly non-competitive environment.

Second, Insurance Claims Representatives moderately value Support. Occupations that satisfy this work value offer supportive management that stands behind employees.

Lastly, Insurance Claims Representatives moderately value Independence. Occupations that satisfy this work value allow employees to work on their own and make decisions.

Psychological Demands

Each occupation brings its own set of psychological demands, which describe the characteristics necessary to perform the job well.

In order to perform their job successfully, people who work as Insurance Claims Representatives must consistently demonstrate qualities such as attention to detail, integrity, and dependability.

Below, you'll find a list of qualities typically required of Insurance Claims Representatives, ranked by importance:

Attention to Detail
Job requires being careful about detail and thorough in completing work tasks.
Integrity
Job requires being honest and ethical.
Dependability
Job requires being reliable, responsible, and dependable, and fulfilling obligations.
Cooperation
Job requires being pleasant with others on the job and displaying a good-natured, cooperative attitude.
Self-Control
Job requires maintaining composure, keeping emotions in check, controlling anger, and avoiding aggressive behavior, even in very difficult situations.

What education and training do Insurance Claims Representatives need?

Working as an Insurance Claims Representative usually requires a high school diploma.

Insurance Claims Representatives need anywhere from a few months to one year of working with experienced employees. A recognized apprenticeship program may be associated with this occupation.

Educational degrees among Insurance Claims Representatives

  • 2.0% did not complete high school or secondary school
  • 23.2% completed high school or secondary school
  • 31.7% completed some college coursework
  • 13.4% earned a Associate's degree
  • 23.3% earned a Bachelor's degree
  • 5.3% earned a Master's degree
  • 1.2% earned a doctorate or professional degree

Knowledge and expertise required by Insurance Claims Representatives

Insurance Claims Representatives may benefit from understanding of specialized subject areas, such as customer and personal service, administrative, or computers and electronics knowledge.

The list below shows several areas in which most Insurance Claims Representatives might want to build proficiency, ranked by importance.

Customer and Personal Service
Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
Administrative
Knowledge of administrative and office procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and workplace terminology.
Computers and Electronics
Knowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
Mathematics
Knowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
Administration and Management
Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.

Important Abilities needed by Insurance Claims Representatives

Insurance Claims Representatives must develop a particular set of abilities to perform their job well. Abilities are individual capacities that influence a person's information processing, sensory perception, motor coordination, and physical strength or endurance. Individuals may naturally have certain abilities without explicit training, but most abilities can be sharpened somewhat through practice.

For example, Insurance Claims Representatives need abilities such as written comprehension, oral comprehension, and oral expression in order to perform their job at a high level. The list below shows several important abilities for Insurance Claims Representatives, ranked by their relative importance.

Written Comprehension
The ability to read and understand information and ideas presented in writing.
Oral Comprehension
The ability to listen to and understand information and ideas presented through spoken words and sentences.
Oral Expression
The ability to communicate information and ideas in speaking so others will understand.
Speech Recognition
The ability to identify and understand the speech of another person.
Near Vision
The ability to see details at close range (within a few feet of the observer).

Critical Skills needed by Insurance Claims Representatives

Skills are developed capacities that enable people to function effectively in real-world settings. Unlike abilities, skills are typically easier to build through practice and experience. Skills influence effectiveness in areas such as learning, working with others, design, troubleshooting, and more.

Insurance Claims Representatives frequently use skills like active listening, reading comprehension, and speaking to perform their job effectively. The list below shows several critical skills for Insurance Claims Representatives, ranked by their relative importance.

Active Listening
Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Reading Comprehension
Understanding written sentences and paragraphs in work-related documents.
Speaking
Talking to others to convey information effectively.
Critical Thinking
Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
Writing
Communicating effectively in writing as appropriate for the needs of the audience.

What is the source of this information?

The information provided on this page is adapted from data and descriptions published by the U.S. Department of Labor, Employment and Training Administration under the CC BY 4.0 license. TraitLab has modified some information for ease of use and reading, and the U.S. Department of Labor, Employment, and Training Administration has not approved, endorsed, or tested these modifications.

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