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.
Claims 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.