Insurance claims representatives handle claims made by clients and protect the company they work for from false or fraudulent claims. They are the first person to handle a claim when one is made. They speak with the client who is making the claim and they determine if the claim is valid or not.
Because insurance claims representatives filter out/catch invalid claims, they therefore protects their company from being taken advantage of or paying undeserved money. If a claim is deserving of compensation though, the representatives code the claim and they recommend how much compensation should be paid.
Insurance claims representatives usually work normal business hours Monday through Friday. They generally work in an office or call center and report to an insurance claims manager. They must have a keen attention to detail and they must be very thorough as many who try to commit insurance fraud have done extensive research on how to try and pull it off. Insurance claims representatives do not need a college degree to be hired; they usually need to have at least a high school diploma and experience is customer service is preferred. However, a large amount of the training for the position comes from the insurance company that hires them.
Insurance Claims Representative Tasks
Performs system functions such as entering information and updates into database.
Provides claim status information to clients.
Verifies accuracy and completeness of insurance claims.
Conducts investigations to determine coverage for claims.