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Claim Representative Jobs (NOW HIRING)

Emergent Holdings

Claim Representative III

Lansing, MI · On-site

Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

AF Group

Claim Representative III

Las Vegas, NV · On-site

Claim Representative III This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

New

AF Group

Claim Representative III

Claim Representative III This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

The AF Group

Claim Representative III

Lansing, MI

Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

Emergent Holdings

Claim Representative III

Lansing, MI · On-site

Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

AF Group

Claim Representative III

Claim Representative III This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

AF Group

Claim Representative III

Phoenix, AZ · On-site

Claim Representative III This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

New

Emergent Holdings

Claim Representative III

Lansing, MI · On-site

Claim Representative III: This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May ...

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How much do claim representative jobs pay per hour?

As of Jul 9, 2026, the average hourly pay for claim representative in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claim Representative, and why are they important?

To thrive as a Claim Representative, you need a solid understanding of insurance policies, strong analytical abilities, and typically a bachelor's degree or relevant experience in insurance or finance. Familiarity with claims management software, CRM systems, and sometimes industry certifications like AIC (Associate in Claims) are common requirements. Excellent communication, negotiation, and customer service skills help you effectively resolve disputes and support clients during stressful situations. These skills are vital for ensuring accurate claim assessments, maintaining customer satisfaction, and upholding the company's reputation.

What are claim representatives?

Claim representatives, also known as claims adjusters or insurance claim specialists, are professionals who investigate insurance claims to determine the extent of an insurance company's liability. They review documentation, interview claimants and witnesses, inspect property damage or injuries, and negotiate settlements. Their role is to ensure that claims are handled efficiently, fairly, and in accordance with policy terms. Claim representatives play a crucial part in the insurance industry by helping resolve claims for policyholders and maintaining trust in the company.

What is the difference between Claim Representative vs Claims Adjuster?

AspectClaim RepresentativeClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licensesHigh school diploma; insurance licenses often required
Work EnvironmentOffice settings, customer interactions, claims processingFieldwork and office work, investigating claims
Employer & Industry UsageInsurance companies, government agenciesInsurance companies, third-party administrators

Both Claim Representatives and Claims Adjusters work in the insurance industry, handling claims and assisting clients. Claim Representatives typically focus on customer service and initial claim processing, while Claims Adjusters investigate and evaluate claims, often in the field. Understanding these differences helps job seekers find roles aligned with their skills and credentials.

What are some common challenges a Claim Representative might face, and how can they be addressed?

Claim Representatives often encounter challenges such as managing a high volume of claims, handling complex or disputed cases, and maintaining clear communication with policyholders, service providers, and legal teams. Developing strong organizational skills and time management strategies can help prioritize tasks effectively. Additionally, staying up to date with industry regulations and company protocols, as well as building rapport with customers, can make navigating difficult situations more manageable and lead to better outcomes for all parties involved.
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Claim Representative jobs near you
Infographic showing various Claim Representative job openings in the United States as of July 2026, with employment types broken down into 81% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.
Claim Representative III

Claim Representative III

Emergent Holdings

Lansing, MI • On-site

Other

Posted 16 days ago

Job description


SUMMARY:
Claim Representative III:
This is the advanced level of the claim handler career path. Investigates claims and exercises significant discretion in the determination of compensability of claims. May handle large, more complex customers requiring high touch, labor intensive claim service. Considers many factors in the determination claim reserves. Negotiates and settles claims within given authority. Mentors lower-level claim handlers. Coordinates special projects and provides guidance to others.
RESPONSIBILITIES/TASKS:
Claim Representative III:
  • Verifies workers' compensation coverage of employers and injured employees.
  • Determines compensability under workers' compensation by thorough investigation of the claim.
  • Determines causal relationship between the reported injury and the incident to ensure appropriate payment of benefits.
  • Facilitate return to work for the injured employee.
  • Establishes timely and appropriate reserves based on the profile of the claim within given authority based on anticipated financial exposure.
  • Documents specifics of claims with potential for subrogation recovery, including amount of potential recovery monies.
  • Manages medical bills for non-indemnity and indemnity claims directly associated with the claimed injury. Approves payment based on knowledge of the treatment plan and medical support showing relationship of treatment to the injury.
  • Concludes and closes files following resolution of claims to meet internal performance standards while complying with state legislation to avoid penalties and manage expenses.
  • Negotiates settlements with attorneys or injured parties within given authority at the earliest possible point to bring cases to final disposition.
  • Works closely with manager on complex files or files above settlement/reserve authority.
  • Manages outside vendors to ensure cost containment efforts.
  • Establishes and maintains effective working relationships with all internal and external customers.
  • Stays abreast of changes in workers' compensation statutes, case law, and rehabilitation efforts/advancements to accurately interpret and apply relevant laws.
ADDITIONAL RESPONSIBILITIES/TASKS:
Claim Representative III:
  • Administers complex claims and catastrophic exposures within authority, including claims from dedicated large accounts.
  • Exercises independent judgment to settle cases prior to mediation or litigation.
  • Actively participates in agent/client relationship management.
  • Assists in mentoring team members.
  • Mentors team members.
  • Conducts audits of claim files.
  • Acts as a backup for team leader.
  • Coordinates special projects.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS
EDUCATION OR EQUIVALENT EXPERIENCE:
Claim Representative III:
Bachelor's degree in a related field. Relevant combination of education and experience may be considered in lieu of degree. Continuous learning, as defined by the Company's learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.
EXPERIENCE:
Claim Representative III:
Five years' experience in a workers' compensation claims environment which provides the necessary skills, knowledge, and abilities, such as experience in reviewing, investigating, and closing complex workers' compensation claims. Experience of handling claims in multiple jurisdictions preferred. Bilingual skills preferred.
OR
Two years of AF Group Claims Representative II experience that includes discretion in determining compensability of complex claims and/or handling complex, high touch or labor-intensive customers.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Claim Representative III:
  • Ability and proficiency in the use of computers and company standard software specific to position.
  • Knowledge of medical and legal terminology related to work.
  • Knowledge of workers' compensation laws and regulations, including jurisdictional laws.
  • Effective oral and written communication skills.
  • Effective customer service skills.
  • Ability to negotiate, build consensus and resolve conflict.
  • Ability to manage multiple priorities and meet established deadlines.
  • Attention to detail and analytical skills.
  • Ability to work independently as well as within a team.
ADDITIONAL SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Claim Representative III:
  • Ability to make independent decisions.
  • Ability to solve complex problems.
  • Ability to train and mentor others.

WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards. Minimal travel required.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $64,900 and $108,700.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge, and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
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