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.
Claims representatives may cover workers compensation programs.
Article Details
  • Originally Written By: Sara Melone
  • Revised By: C. Mitchell
  • Edited By: Lucy Oppenheimer
  • Last Modified Date: 09 December 2014
  • Copyright Protected:
    2003-2014
    Conjecture Corporation
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Becoming a claims representative is usually a matter of cultivating a few basic skills and finding an open position. Insurance companies around the world hire representatives to help them process client claims and deal with problems that people have with their policies. There isn’t usually a lot of specialized education that you’ll have to complete, but in some places you might have to get a license or sit for an official exam. There are a number of different specializations you can choose and these sorts of jobs come in many types. Having some idea of the sort of work you want to do can be useful and can also help you narrow down the field a little bit when it comes time to actually apply. Any experience you can get working within the insurance field will probably help your candidacy, but even things like demonstrated teamwork or experience working with people in a professional capacity can help.

Job Basics

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.

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Educational Requirements

Before you’re eligible 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 university degree as well as a high aptitude in both mathematical and deductive reasoning skills. There are a number of ways to showcase these skills, and in most cases a high school education is all that is strictly required — but university experience is usually essential for advancement. This means that getting at least some postsecondary education will likely help your career trajectory, and will probably make you a more attractive candidate, too.

Degrees in things like business and finance and often the most useful, but it’s usually possible to leverage almost any sort of education into success as a claims representative. There are many different kinds of insurance, which means that even things as disparate as chemistry degree and a certificate in theater can be useful to different parts of the field.

Specializations

Claims reps, also referred to as claim reviewers or claims examiners, may work in a variety of insurance offices managing health care, worker’s compensation, property, casualty or liability insurance claims. More often than not, this sort of person 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 tends to vary between industries, and as a result, familiarity with your specific field of insurance — or even just the basics of that field generally — will usually only help you become a claims representative in that particular area.

Importance of Experience

The easiest way to become a representative is usually to get promoted from within, which is to say to advance up from a general claims filer or other low-level employee with the insurance company. In these instances, employers know that you have at least some familiarity with the work and will be able to effectively manage the representative job. 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.

Boost Your Core Skills

There are also a number of things you can do on your own to boost your expertise and familiarity with many of the core skills the job requires. Regardless of the type of company of general field in which you hope to work, in most cases you’d be wise 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.

Much of the work a claims representative does has to do with financial analysis. Education, experience, and familiarity with financial procedures is therefore important to success on the job. Additionally, since much of the work is logged and processed via computers, data entry and computer knowledge can also be really advantageous.

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 and so-called “people skills” are important as a result. Moreover, because insurance claims resolution often involves high emotions, an ability to deal with irate customers or otherwise tense situations is also usually essential.

Licensure and Job-Specific Training

Depending on the company and location in which you wish to work, you may need a license to work as a claims rep. Some industries and localities require licensure of any claims representatives who process or even just passively view claims. If a license is required, you’ll need to complete a course of study and pass an official government or locality-approved licensing exam. In other places, a company-approved training program is all that is required to become a claims representative.

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