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Claims Customer Service Representative Jobs (NOW HIRING)

Alfa Insurance

Claims CSR II- Opelika, AL

Opelika, AL · On-site

Claims CSR II Alfa Insurance ® is an A-rated insurance carrier that offers an excellent array of auto, home, life, farm and business insurance products. Since its humble beginnings in 1946, Alfa and ...

Jushi USA

Customer Service Representative

Columbia, SC · On-site

$13 - $17.75/hr

Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed. * Researches to ...

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How much do claims customer service representative jobs pay per hour?

As of Jul 5, 2026, the average hourly pay for claims customer service representative 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 are the key skills and qualifications needed to thrive as a Claims Customer Service Representative, and why are they important?

To thrive 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 experience in insurance or customer service. Familiarity with claims management software, CRM systems, and basic office applications is typically required. Empathy, patience, and problem-solving abilities are essential soft skills for effectively assisting customers through stressful situations. These skills and qualifications ensure accurate claim processing, positive customer experiences, and efficient resolution of inquiries.

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

AspectClaims Customer Service RepresentativeClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may prefer insurance certificationsHigh school diploma; state licensing or certification often required
Work EnvironmentOffice setting, customer service calls, data entryField or office, investigating claims, inspecting damages
Employer & Industry UsageInsurance companies, customer service centersInsurance companies, claims departments
Common Search & ComparisonCustomer service, claims support, policy inquiriesClaims investigation, damage assessment, settlement

The main difference is that Claims Customer Service Representatives primarily handle customer inquiries and support related to claims, focusing on communication and policy details. Claims Adjusters investigate and evaluate claims, often inspecting damages and determining settlement amounts. Both roles require insurance knowledge, but their responsibilities and work environments differ significantly.

What does a Claims Customer Service Representative do?

A Claims Customer Service Representative assists customers with filing, processing, and following up on insurance claims. They answer questions about policies, explain the claims process, gather necessary information, and provide updates on claim status. These professionals act as a liaison between customers and insurance adjusters to ensure claims are handled efficiently and accurately. Strong communication, problem-solving, and organizational skills are essential for this role.

What are some common challenges faced by Claims Customer Service Representatives, and how can they be managed?

Claims Customer Service Representatives often handle high volumes of calls from customers who may be experiencing stressful situations. Balancing empathy with efficiency can be challenging, especially when dealing with complex or emotionally charged claims. Developing strong communication and problem-solving skills, along with a thorough understanding of company policies, can help manage these challenges. Many companies provide ongoing training and team support to help representatives maintain a positive and productive work environment.
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Who are the top companies hiring for Claims Customer Service Representative jobs? The top employers for Claims Customer Service Representative jobs are:
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What job categories do people searching Claims Customer Service Representative jobs look for? The top searched job categories for Claims Customer Service Representative jobs are:
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Claims Customer Service Representative jobs near you
Infographic showing various Claims Customer Service Representative job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $41,287 per year, or $19.8 per hour.
Claims/Customer Service Rep

Claims/Customer Service Rep

The Health Plan of West Virginia, Inc.

Charleston, WV • On-site

Other

Posted 19 days ago

Job description

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. Communicte 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. Communicates 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 proved stop loss reporting accuratley 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 accuratly
  10. Keep all member's protected health information (PHI) confidential

8:00am - 5:00pm
40

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