How Do I Become a Claims Representative?

A claims representative works on behalf of an insurance provider to ensure that all guidelines are followed while processing a claim.
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  • Written By: Sara Melone
  • Edited By: Lucy Oppenheimer
  • Last Modified Date: 11 August 2014
  • Copyright Protected:
    2003-2014
    Conjecture Corporation
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The requirements or qualities that will improve your chances of becoming a claims representative varies depending on the company and type of claims representative you want to become. Regardless, you want to develop your skills and experience to show a potential employer that you can take and follow direction, consistently apply the governing rules and policies in place, and maintain confidentiality. Depending on the field that you plan to work in, licensure may be required and therefore some training courses and licensure exams may also be required in order to become a claims representative.

A claims representative works on behalf of an insurance provider to ensure that all guidelines and established rules are followed in the processing of each insurance claim or appeal. When a claim is submitted to an insurance company requesting payment or waiver, it must first be viewed by the claims department. The claims department is charged with checking each particular case against an established set of rules governing such things as the validity of the claim, and the appropriate cost and course of action.

To become a claims representative, you'll most likely need at least a high school diploma. Due to the sensitive nature of claims work, many insurance companies prefer to hire representatives that have a college degree and high aptitude in both mathematical and deductive reasoning skills.

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Also referred to as a claim reviewer or a claims examiner, claims reps may work in a variety of insurance offices managing health care, worker’s compensation, property, casualty or liability insurance claims. More often than not, a claims representative will specialize in the claims of one particular field of insurance, even if the company provides insurance in a variety of areas. How these claims are processed often vary among the industries, and as a result, familiarity with that field of insurance will only help you become a claims representative in that particular field. Some companies require some claims experience, others don't require experience for entry level positions.

Much of the work as a claims representative has to do with financial analysis. Education, experience, and familiarity with financial procedures is therefore important to become a claims rep. Additionally, since much of the processing is logged and processed via computers, data entry and computer knowledge will help you land a job as a claims representative.

Depending on the company and the particular claims rep position, you might find yourself interacting directly with the customer or client. Good customer service skills is therefore an important quality in becoming a claims rep. Moreover, because insurance claims resolution often involves high emotions, an ability to deal with irate customers or otherwise tense situations is important.

The absence of previous claims experience can make it difficult for those looking to break into claims work for the first time, but it is possible. Often, companies will recruit new employees to take part in a training program for new claims representatives. This presents the perfect opportunity for those without prior experience. With a little patience and diligence, it is possible to find such opportunities as they become available and thus fulfill the goal to become a claims representative.

Finally, depending on the company and location you wish to work in, you may have to get a license to work as a claims rep. Some industries and some states require licensure of any claims representatives who process or even just passively view claims. If a license is required, a potential claims representative will need to complete a course of study, and pass an official state-approved licensing exam. In other states, a company-approved training program is all that is required to become a claims representative.

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