15 Claims Representative Skills for Your Career and Resume

Claims representatives are responsible for handling customer inquiries and managing customer accounts. They need to have strong customer service skills and be able to multitask and handle a high volume of work. If you’re interested in a career as a claims representative, learning about the necessary skills can help you prepare for the job.

Organization

Organization is the ability to keep track of multiple tasks and files. As a claims representative, you may need to manage paperwork for several customers at once. Having strong organizational skills can help you stay on top of your work and ensure that all necessary information is available when needed. It’s also important to be organized in general so you can complete other aspects of your life effectively.

Analytical Skills

Analytical skills are the ability to analyze data and information, identify patterns and trends and make logical conclusions based on your analysis. As a claims representative, you may need to review medical records, assess liability and determine if an insurance company should pay for treatment or repair services. Having strong analytical skills can help you make informed decisions that benefit both the customer and the insurance company.

Fraud Detection

Fraud detection is the ability to identify when a customer is lying or exaggerating their claims. Claims representatives use this skill to ensure they are paying customers what they deserve and not overpaying them. This also helps you save your company money by identifying fraudulent activity. You can learn how to detect fraud through training, mentorship and experience in the field.

Subrogation

Subrogation is the process by which an insurance company seeks reimbursement for a loss from another party. For example, if you represent a client who was in a car accident and they were at fault, your employer may seek reimbursement from the other driver’s insurance company. This requires negotiation skills to ensure that your employer receives fair compensation.

Customer Service

Customer service skills are important for claims representatives to have because they interact with customers on a regular basis. Customer service involves providing excellent customer support and ensuring that the customer is satisfied with their experience. This requires having empathy, listening to the customer’s needs and resolving any issues they may have.

Detail Oriented

Detail orientation is the ability to notice and remember small details. As a claims representative, you may need to review documents that include intricate information about an individual’s health history or accident details. Having strong attention to detail can help you process these files accurately and efficiently. It also ensures that you provide customers with accurate information regarding their claim.

Litigation Management

A claims representative needs to be able to manage litigation, which is the process of resolving a dispute through legal action. This includes understanding how to file and track cases in court as well as how to prepare evidence for trial. It also means knowing how to negotiate with attorneys on behalf of your company and being familiar with any laws that may apply to the case.

Negotiation

Negotiation is the ability to reach an agreement with another party. As a claims representative, you may need to negotiate with clients and insurance companies on behalf of your company. For example, if a client has filed a claim for damage caused by a natural disaster, you may work with them to determine how much money they should receive from their insurance company. You can use negotiation skills to help you come to an agreement that satisfies both parties.

Medical Bill Review

Medical billing is the process of submitting claims to insurance companies for medical services. This involves understanding how to code procedures and treatments so that insurers understand what they’re paying for. Medical bill review requires reviewing medical records, examining treatment plans and ensuring that all necessary information has been recorded correctly.

Coordination of Benefits

Coordination of benefits is the ability to understand and explain how a company’s insurance policies work together. For example, if an employer offers health care coverage but not life insurance, you might explain that employees can purchase their own life insurance or ask them if they’d like to add it to their benefits package. This skill requires attention to detail and knowledge of different types of insurance.

Claims Processing

Claims representatives use their knowledge of insurance claims to process and approve payments for clients. This involves reviewing the details of a claim, verifying that the client has sufficient coverage and approving payment from an insurer. To process claims accurately, it’s important for claims representatives to understand how different types of insurance work and what information is necessary when submitting a claim.

Problem Solving

Problem solving is the ability to identify and resolve issues. As a claims representative, you may need to solve problems for customers who have experienced an accident or suffered property damage. For example, if a customer has filed a claim regarding their vehicle being damaged in a car crash, you may be responsible for resolving any disputes between the customer and insurance company. This could involve identifying why the customer’s claim was denied and finding ways to make them happy by providing solutions such as offering a rental car while theirs is being repaired.

Policy Interpretation

A claims representative needs to be able to interpret and apply company policies when working with customers. This involves understanding the various types of insurance, how they work and what each policy entails. It also requires a thorough knowledge of the different types of coverage so you can explain them clearly to your customers.

Investigation

Investigation skills are important for claims representatives because they allow you to gather the information necessary to process a claim. You may need to investigate an accident scene, interview witnesses and examine medical records to determine if a company should pay out on a claim. Your investigative skills can also help you find evidence that supports or denies a claim.

Communication

Communication is the ability to convey information in a way that others can understand. As a claims representative, you may need to communicate with customers over the phone or through email. Strong communication skills allow you to relay details about an insurance claim clearly and concisely so that your company can process it quickly. You also use communication skills when collaborating with other employees on a claim.

How Can I Learn These Claims Representative Skills?

There are a few ways that you can learn the necessary skills to become a Claims Representative. Many of these skills are learned through on-the-job training, so working as a Claims Representative is a good way to learn the skills needed for the job. You can also learn these skills by taking courses or attending seminars that focus on topics such as customer service, fraud detection, and claims processing.