Claim Representative Job Requirements

by Amanda Banach

Claims representatives are employed by insurance companies to initiate, investigate and process claims reported by customers. Claims reps are employed in a variety of fields including automobile, home, health care, life insurance and workers’ compensation and typically specialize in processing claims for one specific industry. Individuals interested in a career in this line of work should review the job requirements to ensure they meet all the qualifications prior to applying for the position.

Customer Service

First and foremost, claims representatives must possess the ability to provide excellent customer service while effectively communicating with customers, vendors and co-workers to obtain all information needed to complete the investigation. Customers can often become irate, and the rep must maintain a high level of professionalism at all times during these interactions.


A minimum education level of a high school diploma or equivalent is required to be considered for an entry-level claims representative position. Candidates who possess job-related college level coursework or specialized training in their occupational field will have a more favorable job outlook. Examples of job-related courses include a medical background for life insurance and medical claims representatives, a legal background for workers’ compensation claims, or an accounting background for financial claims representatives.


Once employed, claims reps must successfully complete a structured on-the-job training program. During the training process, new claims representatives are mentored by more seasoned representatives to learn the processes and procedures they must follow to investigate and settle claims. New hires are walked through the entire process from answering the phones, gathering all required information and making a determination on the outcome of the claim.


Each state establishes its own licensing requirements for claims representatives which consist of either passing a state-approved licensing exam, completing a pre-licensure course, or a combination of both. In addition, claims representatives much complete continuing education requirements in accordance with their state’s licensing guidelines to remain licensed.

Analytical Skills

The role of a claims representative is highly analytical and requires someone who is able to obtain and review claim information, company policies and insurance policy details to make a decision on the approval and/or settlement. This includes verifying all facts reported in the initial claim, reviewing insurance contracts to determine eligibility and coverage and calculating the cost of the property damage and eligible reimbursement amount.

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