A claim representative is a person who works within an insurance company and acts as liaison between the customer and insurance company. This position will generally keep traditional weekday, daytime hours, though many will work evenings and weekend shifts in order to accommodate customers. This position is found in all types of insurance, including property, medical, and life insurance.
A claim representative will often work in an office environment with other insurance personnel. However, light travel is often required to claimants’ homes and other offices. A claim representative will generally be required to have a high school diploma with additional training in business, risk management, or insurance studies. However, particular requirements may depend on the insurance agency.
A claim representative will often have a variety of responsibilities and duties throughout their day. The ability to multitask and maintain organization is an absolute must with this position. Some duties associated with the position may include investigating claims made against an insurance company, determining the accuracy of a claim, investigating the circumstances of a claim, gathering information regarding the claim, attaining information to estimate damages, negotiating a settlement between the claimant and insurance company, ensuring fair and accurate claims, inspecting damage to insured property, performing consultations among claimants and witnesses, meeting with doctors to ensure accurate claims, reading and analyzing police reports, reading and analyzing doctor’s records, examining photographs and diagrams of insured properties, meeting and consulting with lawyers, and coming to an accurate resolution regarding the final decision of the claim. This position requires a person who will be able to operate effectively under high stress conditions.
Claim Representative Tasks
Collect documentation necessary to substantiate claims, noting problems and discrepancies.
Contact insurance companies and other third parties to communicate claims and processes, negotiating when appropriate.
Analyze and process simple and complex claims in accordance with policies.