Insurance companies employ claims representatives to work as the main contact for individuals needing to file claims. Claims representatives guide customers through the claims process, assessing their validity and value. Additionally, they usually have the authority to resolve most uncomplicated, non-injury claims. While these professionals must represent their employer's interests, they must be fair to clients and provide excellent customer service to ensure retention. Claims representatives must make claims adjustment assessments according to company guidelines, but they must also make adjustments fit claimants' needs and expectations. They must also answer any relevant customer questions and information.
The claims representative typically follows a structured claims process involving consultations using company-provided materials and professional estimates to determine repair or replacement value of the claimant’s property. These claims assessments are typically supported by reports - as well as video or photographic evidence - created by the representative. In more complex cases (for instance, those that involve injury or open disputes), the claims representative helps gather data related to the claim for higher-level claims adjustors within the company. In these cases, the representative may act as an intermediary and investigator for the insurance company.
Educational requirements for this position typically include a high school diploma or equivalent. Most employers require or prefer customer service experience as well. Proficiency with basic computer software - as well as excellent communication skills - are needed in this position. Claims representatives typically work in insurance field, and their time is often split between their office and site visits and assessments with claimants.
Claims Representative Tasks
Analyze and process simple and complex claims in accordance with policies.
Contact insurance companies and other third parties to communicate claims and processes, negotiating when appropriate.
Collect documentation necessary to substantiate claims, noting problems and discrepancies.