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LHH US

Claims Customer Service Representative

Atlanta, GA · On-site

$46K - $48K/yr

What You'll Do Customer Service * Handle a high volume of inbound calls from policyholders and providers. * Provide accurate information regarding insurance policies, benefits, coverage, and claims.

AF Group

Claims Customer Service Representative

Supports the customer service work and processes for the Enterprise claims teams as well as the Subrogation Teams. Answers claim inquiries from policyholders, agents, injured workers, attorneys ...

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How much do claims customer service jobs pay per hour?

As of Sep 11, 2026, the average hourly pay for claims customer service in the United States is $19.85, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.63 per hour, depending on experience, location, and employer.

What is a claims customer service representative?

A Claims Customer Service representative is a professional who assists customers with insurance claims, answering their questions, guiding them through the claims process, and resolving issues related to their policies. They act as a liaison between the insurance company and the customer, ensuring a smooth and efficient claims experience. Their role typically includes gathering necessary information, explaining coverage, processing claims, and providing updates on claim status. Strong communication and problem-solving skills are essential in this position.

What are the key skills and qualifications needed to thrive as a claims customer service representative?

To excel as a Claims Customer Service representative, you need strong communication skills, attention to detail, and a high school diploma or equivalent, with some employers preferring prior insurance or customer service experience. Familiarity with claims management software, CRM systems, and basic office applications is typically required. Patience, problem-solving abilities, and empathy help you handle customer concerns and resolve claims efficiently. These skills ensure accurate claims processing, positive customer experiences, and support the overall reputation and efficiency of the organization.

What are some common challenges faced by claims customer service representatives, and how can they be managed?

Claims Customer Service representatives often encounter challenges such as handling emotionally distressed customers, managing high call volumes, and navigating complex claim processes. Effective communication, empathy, and strong organizational skills are crucial for managing these situations. Many organizations provide ongoing training, support from supervisors, and access to knowledge bases to help representatives resolve issues efficiently and maintain customer satisfaction.

What is the difference between Claims Customer Service vs Claims Adjuster?

AspectClaims Customer ServiceClaims Adjuster
CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma; state licensing or certifications often required
Work EnvironmentOffice setting, customer support centersField and office settings, investigating claims
Employer & IndustryInsurance companies, customer service centersInsurance companies, adjusting claims on-site or remotely
Primary FocusAssisting policyholders, answering inquiries, processing claimsEvaluating damages, determining claim validity, settling claims

Claims Customer Service roles focus on assisting policyholders with inquiries and processing claims, while Claims Adjusters evaluate damages and determine claim validity. Both roles require insurance knowledge and customer interaction but differ in responsibilities and work environment.

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States with the most job openings for Claims Customer Service jobs include:

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For Claims Customer Service jobs, the most frequently searched job titles are:

Claims Customer Service jobs near you
Infographic showing various Claims Customer Service job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $41,287 per year, or $19.8 per hour.

Claims/Customer Service Rep

Charleston, WV • On-site

The Health Plan of West Virginia Inc
Insurance Services • 51 - 200 employees
Learn more about The Health Plan of West Virginia Incexternal

Other

Re-posted 27 days ago

Job description

Claims/Customer Service Representative

The Claims/Customer Service Rep works with Reinsurance Carriers in filing for reimbursement for groups that have claimants that have gone over the Specific Stop Loss deductible. The Stop Loss Analyst also works with The Health Plan's Account Executives, Claims Team, Financial and Eligibility Teams in order to obtain information needed for the Reinsurance Carrier to reimburse funds to the group. The Claims/Customer Service Rep runs monthly reporting to send out to stop loss carriers, reviews reports to see if claims have exceeded the specific deductible and files any claims over the deductible with the stop loss carrier for reimbursement to the Client. The Claims/Customer Service Rep reviews monthly aggregate reports to see if Monthly Aggregate Accommodation needs to be filed and will file as required. The Claims/Customer Service Rep also reviews Level Funding stop loss reporting submitted by finance to determine if a reimbursement request needs to be filed and will file as required.

Required:
  1. High School graduate or equivalent
  2. Motivated and works independently
  3. Detail oriented with good problem solving skills
  4. Ability to prioritize and meet deadlines
  5. Maintains confidentiality
  6. Proficient in Microsoft Office products (Word, Excel)
  7. Easily adapts to changes in work requirements
Desired:
  1. Previous experience with claims processing and/or call center
  2. Knowledge of stop loss
  3. Two (2) years of experience in a claims processing environment with experience in all claim types
  4. Familiar with client reports, Member EOB's Databytes (BI reporting) and assessing with accuracy and validity of report data
Responsibilities:
  1. Maintain a positive working relationship with others
  2. Communicate with internal and external customers in a timely, professional and friendly manner
  3. Determine claims potentially eligible for filing
  4. Demonstrate the proper sense of urgency needed for obtaining all information for filing or preparing to file stop loss claims
  5. Communicate with Account Executives to obtain information from the Client required by the stop loss carrier
  6. Files stop loss claims in an accurate, complete and timely manner
  7. Run and/or prove stop loss reporting accurately and timely including both internally and externally
  8. Works with stop loss carriers, Account Executives, Claims Team, Financial and Eligibility Departments to resolve issues at the root cause
  9. Records and communicates all information clearly and accurately
  10. Keep all member's protected health information (PHI) confidential

8:00am - 5:00pm 40

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